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Sbort TEalfcs 
Wttb ^oung /Ifootbers 

ON THE MANAGEMENT OF INFANTS 
AND YOUNG CHILDREN 



Charles Gilmore Kerley, M.D. 

Lecturer on Diseases of Children, New York Polyclinic Medical School 

and Hospital: Assistant Attending Physician, Babies' Hospital, 

New York : Physician of the Out-Patient Department 

Babies' Hospital, New York ; Member of 

the American Paediatric Society 



G. P. PUTNAM'S SONS 

NEW YORK & LONDON 

Gbe Ikmckerbocfcer press 

1901 



THE U8RARY OF 

CONGRESS, 
Two Copies Received 

OEC. 16 1901 

Copyright entry 

CLASS a/XXc. No 

COPY B. 






f' 



ix 



Copyright, 1901 

BY 

CHARLES GILMORE KERLEY 



TTbe Ifcnfcfterbocftet press, mew Jgorfe 



TO 
L. EMMETT HOLT, M.D. 

Clinical Professor of Diseases of Children in the College of Physicians 
and Surgeons (Columbia University) New York 

THIS WORK IS INSCRIBED 

IN RECOGNITION OF HIS HIGH PROFESSIONAL ATTAINMENTS AND 

ENTHUSIASM IN PROMOTING THE STUDY OF DISEASES 

OF CHILDREN, AND IN GRATEFUL APPRECIATION 

OF MANY ACTS OF KINDNESS 



PREFACE 

THE aim of this book is to help the 
young mother to a closer acquaint- 
ance with and a more intelligent apprecia- 
tion of the nature and demands of the 
little life entrusted to her care. 

In its preparation the author has kept 
in mind and has endeavored to answer 
the personal questions of many, thought- 
ful young mothers. The better-class young 
mother of the present day is not content 
with the meagre information possessed by 
her mother and grandmother. 

Suggestions relating to medical treat- 
ment are intentionally avoided. A mother 
should know all the details of the child's 
feeding, clothing, bathing, and airing, and 
what to do in an emergency. She should 
also be able to recognize symptoms of 
illness and appreciate their significance. 
She is not supposed to be skilled in the 
use of drugs. 



INDEX 








PAGE 


Adenoids 103 


Appetite 










109 


Baby-basket . 










1 


Barley jelly . 










261 


Barley-water . 










261 


Basket for early exercise 








• 250 


Bath. 










Basin for fever 








85 


Bran 










87 


Brine 










. 86 


In hot weather 










85 


Mustard . 










86 


Soda 










87 


Starch 










87 


Tub for fever 










85 


Bathing 










83 


Bed-wetting . 










219 


Beef broth 










260 


Beef juice 










260 


Bites of animals . 










183 


Bites of insects 










182 


Boils . 










179 


Breast and nipples, care of . 








26 


Bronchitis 










133 



Vlll 



Index 







PAGE 


Bruises . 




• 231 


Burns . 


■ 


. l8l 


Chicken broth 




260 


Chicken-pox 


. 


' 157 


Children's parties . 




. ' . 247 


Circumcision 




224 


Cleanliness . 




• 237 


Clothing for the expected baby 


3 


Cold hands and feet 


. 


• 237 


Cold in head 




. 132 


Colic . 


. 


. 205 


Constipation . 




210 


Contagious diseases 




142 


Convulsions . 


. 


201 


Cough . 




. . .130 


Croup. 






Catarrhal 


. 


. 136 


Diphtheritic . 




. . 136 


Crying . 




• 235 


Cuts 


• 


. 231 


Days to go out 




246 


Dentition 




. 91 


Dextrinized barley-water 


262 


Diet. 






From one to two 


years of age 


. 49 


From two to three years of ag 


e • -55 


From three to six 


years of ag< 


5 . " . 56 


Diet during illness 




. 68 


Diphtheria 


. 


• iS3 



Index 



IX 





PAGE 


Disinfectant drugs .... 


163 


Disinfection for contagious diseases 


. .64 


Drug-giving ...... 


• 245 


Earache ...... 


. S8 


Ear-pulling ...... 


. 116 


Eczema ...... 


170 


Eczema intertrigo .... 


. 174 


Egg-water ...... 


261 


Enlarged tonsils ..... 


107 


Excitement ...... 


• 232 


Exercise pen ..... 


2 54 


Eyes 


90 


Feeding. 




Artificial ..... 


34 


Bottle 


34 


Fever 


184 


First duty to the child .... 


4 


Fissures of the anus .... 


178 


Flies, dangers from .... 


240 


Food preparation ..... 


39 


Foreign bodies in the ear and nose 


240 


Foreign bodies swallowed . 


238 


Formulae for bottle-feeding . 


4i 


Fumigation ...... 


164 


Genitals, care of 


222 


German measles ..... 


147 


Glands, acute enlargement of 


167 


Glands, chronic enlargement of . 


169 


Grippe 


198 



Index 



Habits .... 








• ii3 


Hair . . 






• 97 


Head lice .... 






. 181 


Height 






10 


Hives ..... 






172 


How the child should be fed 






• 58 


How to examine the throat . 






. 119 


How to lift the baby 






10 


Kissing .... 






• 234 


Malaria .... 






. 186 


Malnutrition . 








. 72 


Marasmus 








• 72 


Masturbation 








117 


Maternal nursing . 








13 


Measles .... 








158 


Milk, condensed . 








60 


Milk-crust . 








174 


Milk for travelling 








67 


Milk in infants' breasts 








108 


Milk, peptonized . 








66 


Milk, selection of . 








32 


Mosquitoes, dangers from 








240 


Mumps .... 








148 


Mutton broth 








260 


Night terrors . . 






251 


Normal throat, the 






118 


Nose-bleed 






227 


Nursery-maids . . . . 






99 


Nursery, the . 








10 






Index 



XI 











PAGE 


Nursing-bottle and nipple .... 32 


Nursings for twenty-four hours 






2 3 


Oatmeal jelly 






261 


Pacifier, the . 








114 


Painful micturition 








224 


Patent medicines . 








242 


Pneumonia . 








13s 


Prickly heat . 


. 






177 


Proprietary meal foods 


• 






64 


Quarantine . 








162 


Retention of urine 


. 






225 


Rice-water 


. 






262 


Rickets 








191 


Rheumatism . 








196 


Scales for weighing 








253 


Scarlet fever . 








144 


Scraped beef 


. 






261 


Scurvy . 








194 


Second summer, the 






5o 


Sick-room for contagious diseases 




162 


Simpson medicine satchel 




238 


Skin in health, the 






169 


Sleep 


. 






234 


Sore mouth 


• 






I2 3 


Sprains .... 


. 






231 


Summer diarrhoea 


. 






77 


Summer resorts 


. 






243 


Stomatitis 


. 






I2 3 


Taking cold . 


. 






J 25 



Xll 



Index 



Teeth ..... 






. 96 


Teeth, care of 






97 


Temperature, and how to take it 






108 


The well baby 






5 


Thrush . 






121 


Tonsillitis .... 






131 


Trained nurse, the 






TOI 


Tuberculosis 






188 


Vaccination .... 






217 


Vomiting .... 






70 


Vomiting, habitual 






71 


Weaning . 






30 


Wet-nurse, the 






23 


Wheat jelly .... 






26l 


When to send for the doctor 






241 


Whey 






262 


Whooping-cough . 






*5* 


Worms . 






228 



ILLUSTRATIONS 



Baby-Basket 








PAGE 

2 


Basket for Early Exercise 








■ 251 


Chapin Dipper 








■ 39 


English Breast-Pump . 








29 


Exercise Pen 








257 


Freeman Pasteurizer 








48 


Graduate (One Pint) 








4i 


Nipple-Shield 








28 


Nursing-Bottle and Nipple 








33 


Scales for Weighing 








254 


Simpson Satchel . 






. 259 


Throat Examination 








120 



SHORT TALKS 
WITH YOUNG MOTHERS 



THE BABY-BASKET AND ITS CONTENTS 

(See Fig. i.) 

A BASKET in which all the toilet 
necessities for the baby may be kept 
together will be found a great conven- 
ience when the time for their use arrives. 
The tray should also contain a good- 
sized pin-cushion. Other necessary arti- 
cles are : 

i . Puff-box and puff. 

2. Soap-box, containing Castile soap. 

3. Infant's hair-brush and fine comb. 

4. Eight ounces of a saturated solution 
of boracic acid for mouth and eyes. 

5. One-half pound of absorbent cotton. 

6. A package of wooden toothpicks. 

7. A bottle of white vaseline. 



The Baby-Basket 



8. A bath thermometer. 

9. One yard of plain sterile gauze. 

10. Plenty of soft old linen 

11. Six of the best baby towels. 







FIG. I. BABY-BASKET 

12. A white eiderdown blanket one and 
one-half yards long. 

13. One pair of small scissors. 

14. A package of nickel-plated safety- 
pins (three sizes). 



Clothing 3 

15. One yard of the best white flannel 
for abdominal binders. 

CLOTHING TO BE PROVIDED FOR THE 
EXPECTED BABY 

These are the articles that are abso- 
lutely necessary. More elaborate prep- 
arations are made for some children. 
This list, with the contents of the baby- 
basket, comprises everything that is re- 
quired during the first few weeks, 

1. Forty-eight cotton diapers, made 
from Birdseye cotton diaper ; two sizes 
are necessary. 

(a) Three pieces 20 in. 

(b) Three pieces 22 in. 

2. One yard of w 7 hite flannel for belly- 
bands. Leave the piece as it is v to be 
used by the trained nurse as required. 
After the sixth week knitted bands with 
shoulder straps are preferable. 

3. Four second-size silk-and-woo! shirts. 

4. Six pinning blankets made of white 
flannel with cotton bands. 

5. Three flannel skirts, 

6. Three white skirts. 



4 First Duty to the Child 

7. Six night slips to be used day and 
night for five or six weeks. 

8. Six day slips as plain as possible, 
bishop style. 

9. Three eiderdown wrappers. 
10. Three cashmere sacques. 

ADDITIONAL NEEDS 

i. Three bath aprons for the mother or 
nurse, to be used to cover the baby after 
he is taken from the bath. These should 
be made of shaker flannel. 

2. Three pads, each one yard square, 
and three more, each on'e-half yard square. 
These are necessary for the crib and lap. 

THE FIRST DUTY TO THE CHILD 

With the severing of the umbilical cord 
the child begins an independent existence. 
It is made to cry, the eyes and mouth 
receive attention, when it is wrapped in a 
soft, warm blanket and placed out of 
draughts until it can be given further at- 
tention. During the excitement of the 
occasion and the needs of the mother the 
baby is sometimes neglected, often with 



The Well Baby 5 

serious consequences. A few months ago 
I saw, with another physician, a fatal case 
of pneumonia in a child four days old, the 
disease being due in all probability to 
neglect. It must not be forgotten that 
the baby has been suddenly transported 
into an entirely different sphere of action 
from that to which he is accustomed, and 
we must make the change as easy for him 
to bear as possible. As soon as the nurse 
can devote her attention to the baby he 
should be gently and thoroughly oiled 
with liquid albolene or sweet oil. This is 
to be followed by a sponge bath with luke- 
warm water and castile soap. The stump 
of the cord should be dusted with some 
dry antiseptic powder and wrapped in dry, 
plain sterile gauze. The cord, particularly 
at its junction with the abdomen, should be 
thoroughly dusted twice a day. When it 
falls off, the parts should be kept dusted 
and dry until cicatrization is complete. 

THE WELL BABY 

In order to appreciate disease or failure 
in proper growth and development, it is 



6 The Well Baby 

necessary to know what constitutes a well 
baby. The well baby grows steadily, 
shows an increase in weight of from five 
to six ounces a week, the muscles are 
firm, the skin clear, and the eyes bright. 
When hungry he makes it known by crying 
lustily. At the completion of the feeding 
he gives evidence of comfort by drowsi- 
ness, or by falling asleep. There are two 
or three soft yellow stools daily. After the 
second month the well baby appreciates 
a moderate amount of attention, and is at- 
tracted to bright objects and pleasant faces. 
His sleep is restful and he wakes quite nat- 
urally. It is not to be understood that the 
well baby cries only when hungry. He 
often cries while being undressed, when 
the clothing is uncomfortable, when objec- 
tionable people appear before him, or 
when suffering from transient pain. 

At the third or fourth month he should 
be able to hold his head erect without 
support ; from the sixth to the seventh 
month — at this time the first tooth is usu- 
ally cut — he acquires the power of sitting 
up without assistance ; from the ninth 



The Weight of the Well Baby 7 

to the tenth month he begins to creep, 
and from the twelfth to the eighteenth 
month he learns to walk alone. A very 
few children walk alone before the twelfth 
month ; the great majority, however, are 
from fifteen to eighteen months of age 
before this important feat is accomplished. 
There is nothing to be gained and much 
harm may be done by parents favoring 
early walking. When the child learns to 
walk unaided it is usually safe to allow 
him to continue. 

THE WEIGHT OF THE WELL BABY 



Average weight 


at birth 


7- 55 


lbs. 


7 


16 lbs. 


" * v 


" three months 


11.75 




i !I 


5 " 




" six months 


16. 


kv 


15 


5 " 


4i 


11 nine months 


18. 




17 


75 i% 


* 4 


"' twelve months 


20 


■'• 


i I9 


8 " 




11 eighteen months 


22.8 


kC 


22 


" 




44 two years 


26.5 




i 2 5 


5 ;; 


4< »; 


11 three years 


31-5 


44 


30 




tt ll 


" four years 


35- 


i ' 


34 


44 


4. i. 


" five years 


41.2 


* l 


39 


8 :i 


!•.• 


" six vears 


45-1 




43 


8 ■' 



Every child under one year of age 
should be weighed once a week. The 



Pr L. Emmett Holt, Diseases of Infancy and Childhood. 



8 The Weight of the Well Baby 

very weak and delicate and those who are 
being put through a new course of dietetic 
treatment on account of failure in growth, 
should be weighed two or three times a 
week. A child is doing fairly well who 
gains on an average four ounces a week, 
ten months in the year. Such a child, 
however, needs careful watching. If a 
child gains from six to ten ounces a week 
we are perfectly satisfied with his progress. 
The use of the weight chart which is 
tacked on the wall of the nursery I do 
not advise. Such a chart, while recom- 
mended by many well-known writers, has 
been the cause of serious trouble. The 
mother and nurse wish baby's weight chart 
to make a good showing, — to show some- 
thing phenomenal if possible, for the ad- 
miration of relatives and friends. Some 
perfectly well, vigorous babies increase in 
weight slowly ; but a gain of only four or 
five ounces a week, — so much below the 
standard of her neighbor, makes a very 
unsatisfactory chart and the mother in 
consequence begins to worry, fearing that 
her baby is not being properly nourished. 



The Weight of the Well Baby 9 

Worry and anxiety have caused the milk 
of hundreds of mothers to fail, and ren- 
dered further nursing impossible. If the 
babe is wet-nursed and the chart does not 
show a large gain, the mother scolds, the 
family generally is dissatisfied, the nurse 
becomes angry, and, fearing lest she lose 
her position, her milk soon fails and she 
is unable to nurse the baby. If the baby 
is bottle-fed, there is a strong tendency to 
overfeed him in order to make a pretty 
chart, and as a result the child is made 
ill. 

The gain in weight is much less in sum- 
mer than during the cooler months. I 
have seen many children in perfect health 
pass through July and August without 
gaining an ounce ; but with the arrival of 
cooler weather they will surely make up 
for the time lost. There is usually a de- 
cided loss in weight the first four days of 
life. This loss — from a quarter to a half 
pound — will usually be regained in five or 
six days if the child is properly fed. At 
the end of the first year the child should 
weigh two and one-half times as much as 



IO 



The Nursery 



at birth. There should be a gain of about 
seven pounds during the second year. 



HEIGHT IN 



At Birth. 
Boys, 20.6 
Girls, 20.5 

18 months 
Boys, 30 
Girls, 29.7 

Four years 
Bovs, 38 
Girls, 38 



INCHES FROM BIRTH TO 
SIXTH YEAR 



6 months 
25.4 
25 

Two years 
32.5 
3 2 -5 

Five years 

4i 7 
41.4 



12 months 

29 

28.7 

Three years 
35 
35 

Six years 
44. T 
43-6 



HOW TO LIFT THE BABY 

A baby should be lifted by placing one 
hand under the buttocks and the other 
under the head. Until the fifth or sixth 
month is reached, a child should never 
be raised with the head unsupported. 

THE NURSERY 

The room used for the nursery should 
be the best in the house. If possible it 
should be on the top floor, with at least 
two windows and a southern exposure. 
The furniture and furnishings should be 



The Nursery u 

of the simplest. Enamelled bedsteads 
and only plain furniture which can be 
washed should be used. A hardwood 
floor is best because it is easily cleaned 
with a damp cloth ; a broom should never 
be used in the nursery, as it stirs up the 
dust, which deposits itself in another 
place. Rugs may be used on the floor, 
but they should be removed and beaten 
every day. The walls should be of hard 
finish or painted. There should be an 
open fireplace in every nursery, not neces- 
sarily for heating purposes but for venti- 
lation. Usually the open grate and the 
windows are the only means of ventilat- 
ing the nursery. The window ventilating- 
board is of considerable value. I always 
advise its use. It is a board about four 
inches in width which fits tightly beneath 
the lower sash. This leaves an open 
space between the sash which allows the 
entrance of a current of air, which is 
directed upward. 

There should be two shades to each 
window, a white shade and a dark 
shade. The furnace, with its dry heat, is 



12 The Nursery 

preferred to steam with its uncertainties. 
The temperature of the steam-heated 
room is hard to regulate, being very- 
high at one time and low at another. 
In many apartments the fire is not kept 
going at night, and in cold weather the 
temperature of the rooms often falls to 
6o° or 55 . This is decidedly injurious. 
The child perspires from the heat of the 
room in which he is put to bed, kicks off 
the bedclothes, and becomes thoroughly 
chilled when the temperature falls. There 
should be a thermometer in every nursery 
which should not be allowed to register 
above 72 or below yo° during the day 
or above 68° or lower than 65 at night. 
In houses where steam is the only 
means of heating, as is the case in 
thousands of New York homes, some 
means must be at hand which can be 
called upon at a moment's notice to 
furnish the required heat. The grate 
fire answers well for this purpose. The 
popular gas log is better than no heat 
at all. 

The nursery must be given an hours 



Maternal Nursing 13 

airing twice a day, — one-half hour in 
the morning, and one-half hour in the 
afternoon. Napkins must not be dried 
in the nursery but washed after each 
soiling. Vessels containing urine should 
not stand in the nursery. 

The child should sleep alone in his 
crib. The old-fashioned cradle in which 
several generations have been rocked is 
an interesting heirloom, but under no cir- 
cumstances should it be removed from its 
corner in the garret. The modern baby 
should never be rocked. 

MATERNAL NURSING 

In New York City proportionately 
fewer children are nursed by the mother 
each succeeding year. The social con- 
ditions of our time are against the devel- 
opment of those requirements so essen- 
tial for the proper performance of all 
the functions of motherhood. 

A nursing mother, in addition to being 
in fair physical condition, should be men- 
tally at rest. This is not the case with the 
sensitive, overtrained, and impressionable 



H Maternal Nursing 

women of our better classes. A nursing 
mother should worry little, and have no 
anxiety for the morrow. A mother, to 
nurse her child successfully, must be 
a happy, contented woman. It is the 
lack of happiness, — the absence of con- 
tentment that pervades all classes, that 
renders women unable to nurse their 
children. 

The American women of our large cit- 
ies assume the cares and responsibilities 
of life equally with men. Among the so- 
called higher classes, — those who have all 
that wealth and position can give, — there 
is a constant struggle for social pre-emi- 
nence. Among the majority of the so- 
called middle classes the contest for 
wealth and place never ceases from the 
moment the school days begin until death 
or infirmity closes the scene. Among 
the poor there are the ceaseless toil, the 
struggle for food and shelter, the care of 
the sick, and the frequent deaths of little 
ones in the family whom they are unable 
properly to care for. In all classes, there- 
fore, the conditions of life are such as 



Maternal Nursing 15 

seriously to interfere with the normal 
function of nursing, no matter how excel- 
lent may be the mother's physical con- 
dition. As a rule the phlegmatic mother 
who thinks the least makes the best wet- 
nurse. It is not implied that brains and 
successful nursing do not go together, 
but mental dulness and the ability suc- 
cessfully to carry on this function are far 
more frequently found associated. Our 
best wet-nurses are the European peas- 
ant women. Neither they nor their an- 
cestors were ever known to exercise what 
brain power they may have possessed. 
Every mother in good health should 
make the attempt to nurse her baby ; 
it is better for the mother, it saves 
much trouble, and it may save the baby's 
life. 

From six to ten hours after labor, 
the mother's nipples should be washed 
with a saturated solution of boracic acid, 
dried, moistened with alcohol, and the 
baby put to the breast. After this it 
should be done at regular intervals every 
two or three hours. This may seem 



1 6 Maternal Nursing 

useless, as the milk does not appear in the 
breasts until from forty-eight to seventy- 
two hours afterward. Of course, there will 
be no great attempt at drawing on the 
nipples, but it will be sufficient to accus- 
tom them gradually to their new office, 
so that when the milk suddenly rushes 
into the breasts, as it often does, both 
baby and nipples are prepared for their 
work. Before the milk appears the baby 
can be given a solution of sugar of milk, 
— a teaspoonful of sugar of milk to one- 
half pint of boiled water. Of this solu- 
tion from one-half to one ounce may be 
given every two or three hours. 

With the commencement of nursing 
accustom the child to getting its food at 
stated intervals. Between 6 a.m. and 
10 p.m. there should be nine nursings. 
Between n p.m. and 6 a.m. only one 
nursing should be given and that at 
2.30 A.M. 

There are many mothers who cannot 
nurse their babies, and there are mothers 
who, although they have plenty of milk, 
should not be allowed to nurse their 



Maternal Nursing 17 

babies. Among such mothers may be 
included consumptives and those who 
have a strong hereditary tendency to 
tuberculosis. Pale, anaemic women are 
usually poor wet-nurses. They often 
begin well but the milk soon fails. 
Women who become mothers for the first 
time after reaching the age of thirty- 
five make indifferent wet-nurses, as also 
do those who become mothers before 
eighteen or nineteen years of age. Other 
things being equal, from the twenty-first 
to the thirty-fifth year is the most suc- 
cessful nursing period. In most instances 
frequent child-bearing precludes nursing. 
Upon the advent of pregnancy the nurs- 
ing must be stopped at once. As previ- 
ously stated, the nervous, worried mother 
is also an utter failure at nursing. 

What are the signs of successful nurs- 
ing ? 

In a previous chapter it was stated 
that the baby should gain not less than 
four ounces per week ; the benefit of 
the weekly weighings is now apparent. 
The weighings keep us in touch with 



1 8 Maternal Nursing 

the child, but we need not always depend 
upon them to determine whether the 
child is properly nourished. When a 
baby is nursed at proper intervals, and 
the milk is sufficient and of good quality, 
he appears satisfied at the completion of 
the nursing. Sometimes he falls asleep, 
sometimes he feels a bit drowsy, but at 
all times he is comfortable. When the 
nursing hour again approaches, he be- 
comes restless and unhappy, crying lustily 
if the nursing is much delayed. When 
the breast is offered he takes it greedily 
and is satisfied in from ten to fifteen 
minutes. His stools are yellow and 
number two or three daily. Such a child 
should gain from six to ten ounces weekly 
and will sometimes gain more. The 
child for whom the supply of milk is 
insufficient, or with whom it does not 
agree, is entirely different. If the milk 
is lacking in quantity, the child remains 
long at the breast — perhaps from one- 
half to three-quarters of an hour. When 
removed he is restless and uncomfortable ; 
in a short time — in an hour or less — 



Maternal Nursing 19 



he seems to be very hungry and demands 
frequent nursing both day and night. 
The milk may be sufficient in quantity 
but poor in quality, or it may be too 
rich ; whatever may be wrong, the child 
is uncomfortable a greater part of the 
time, and is considered a very cross baby. 
There is always more or less colic, and 
there may be constipation or diarrhoea. 
The stools are often green and contain 
mucus. Frequently there is slight vomit- 
ing. The child who does not get milk 
enough and the child whose milk is un- 
suitable alike fail to thrive. They make 
little or no gain in weight ; sometimes 
there is decided loss ; they are pale, 
pinched babies. 

Normal mother's milk is of a bluish- 
white color. Upon standing twelve hours 
in a narrow glass, a firm layer of cream 
will form on the top. If, however, the 
cream forms in flakes we know the milk 
is deficient in fat. Chemical examination 
of the milk alone can determine correctly 
what deficiency there may be. The phy- 
sician is then able intelligently to treat the 



20 Maternal Nursing 

mother with a view to improving the 
quality of the milk. So much may be 
done in this respect that often nursing 
may be successfully continued. Every 
case, particularly if it presents grave dif- 
ficulties, will require special treatment. 
Much improvement in the nursing capa- 
city will be observed, hbwever, if the fol- 
lowing rules are followed, not for one or 
two days, but for every day : 

The nursing mother should be temper- 
ate in all things. She should be free from 
unusual care and anxiety. A child will 
not thrive on fretted milk. 

She should sleep at least eight hours, 
preferably ten, out of the twenty-four. 

She should walk or drive from two to 
four hours daily. 

The bowels should move once every 
day. 

The nursing mothers diet should be 
plain and substantial. It should consist 
of soups, bread and butter, cream, cereals, 
green vegetables, rare lean meats, poultry, 
fish, stewed and ripe fruits, milk, cocoa, 
chocolate, and plain cake. 



Maternal Nursing 21 

To be avoided are rich, highly-seasoned 
foods of all kinds, with rich gravies, 
sauces, and puddings and pies. Condi- 
ments may be taken in moderation. One 
or two cups of coffee may be allowed 
daily, but tea should form no part of the 
dietary of the nursing mother. Constipa- 
tion is a very frequent disorder among 
mothers. Time and again I have seen a 
baby ill from this cause alone. Constipa- 
tion, indigestion, and colic is the usual 
combination in the nursing child. Babies 
occasionally become ill during the men- 
strual period of the mother, but it rarely 
amounts to more than a slight attack of 
indigestion, which is relieved in a day or 
two without any special treatment. 

Any sudden mental impression upon 
the mother, whether of a pleasant or a 
disagreeable nature, will often act as a 
shock and produce an attack of vomiting 
and diarrhoea in the infant. 

It is my custom to advise that the baby 
be trained to the bottle at an early age, 
even though the mother is nursing him 
satisfactorily. The chief advantage of a 



22 Maternal Nursing 

daily bottle-feeding is, that it affords the 
mother greater freedom, — more time for 
recreation and enjoyment. If a baby has 
to be nursed every two or three hours, it 
means that the mother cannot get very 
far from the baby. The bottle-feeding 
will allow her to go to the theatre, to go 
shopping or calling on her friends. 
Further, if the mother is called from 
home, or if she is taken ill, the baby's 
nourishment will have been provided for. 
The formula used should correspond to 
the age of the child, as suggested in the 
chapter on bottle-feeding. At the seventh 
month one or two bottle-feedings will be 
required daily. At an earlier period, if 
the milk fails, it may be supplemented by 
bottle-feedings ; the bottle may be given 
every third feeding or every second feed- 
ing. If a mother cannot nurse her child 
satisfactorily every second feeding, the 
nursing would better be discontinued. 

The great majority of breast-fed child- 
ren are weaned before they are twelve 
months old, and wisely so. If a child can 
be nursed five months he has a great 



The Wet-Nurse 23 

advantage over one that has been bottle- 
fed from birth. If he can be nursed for a 
longer period, — up to the ninth or tenth 
month, — so much the better for the baby. 

NURSINGS FOR TWENTY-FOUR HOURS 

Third to twenty-first day . . . 10 nursings. 

Third to sixth week 9 

Sixth to twelfth week 8 " 

Third to fifth month 7 " 

Fifth to seventh month. ... 6 to 7 

Seventh to twelfth month 5 to 6 

THE WET-NURSE 

The employment of a wet-nurse should 
be decided upon only when all other means 
of nourishment fail. The wet-nurse should 
not be under the age of twenty-two, or 
over thirty-five years. The age of her in- 
fant should correspond within a month or 
six weeks with that of the baby she is 
to nurse. The uneducated and naturally 
stupid make better wet-nurses than the 
educated and impressionable. As a rule, 
the German, Austrian, and Russo-Polish 
peasants make the best wet-nurses. Irish 
girls occasionally make good wet-nurses, 



24 The Wet-Nurse 

but they lack the strength of the types men- 
tioned and excel in temper. Whether 
the wet-nurse is married or not should 
exert no influence upon her selection, 
which is made for a purely animal func- 
tion. Both the wet-nurse and her baby 
should be passed upon by a physician be- 
fore she is engaged. I have heard from 
time to time of good wet-nurses, — those 
who could nurse a baby satisfactorily and 
were in no way objectionable. It has not 
been my lot to meet such a one. Those 
with whom I have come in contact re- 
quired constant watching as to bowel 
function, cleanliness, and exercise. The 
diet of a wet-nurse should be plain, the 
same as suggested in a previous chapter 
for a nursing mother. There is a strong 
tendency to indulge the wet-nurse. She 
is, for the time, the most important indi- 
vidual in the family, next to the baby, 
and is often pampered and overfed. She 
has been accustomed to hard work and 
plain food. Rich food and idleness soon 
result in illness, the baby suffers, and an- 
other wet-nurse must be secured. From 



The Wet-Nurse 25 

the commencement of her engagement 
the time of the wet-nurse should be kept 
fully occupied. She should take two or 
three hours' exercise in the open air every 
day and should be given some simple do- 
mestic duties to perform, such as sewing 
or assisting in the kitchen or with the up- 
stairs work. If the wet-nurse is a success 
she must never learn her value, for when 
this is once discovered there is but little 
peace for the household while she is a 
member of it. It is astonishing in how 
many ways one of these women can make 
herself disagreeable ! 

Every wet-nursed baby should receive 
one bottle-feeding daily, so that should 
the wet-nurse be taken ill or have to 
be discharged the baby will not suffer. 
Further, if she knows she can be dis- 
pensed with, the conduct of the wet- 
nurse will be much better. 

Considering the matter from the stand- 
point of the wet-nurse a few hints may 
not be amiss. She was eno-aored as 
wet-nurse and should not be expected 
to do the family washing or cooking. 



26 Care of the Breasts and Nipples 

Further, she should not be <4 nagged " 
continuously, nor berated for every 
stomach-ache, nor criticised if the baby 
does not make a satisfactory gain in 
weight. She should not be condemned 
if the child does not do well at first on 
her milk. She has left her own baby and 
is living in entirely different surround- 
ings, and it would not be strange if for 
a day or two her milk had an unfavora- 
ble influence on the baby. 

CARE OF THE BREASTS AND NIPPLES 

After nursing is well established the 
baby should be nursed at about two-hour 
intervals during the day. From 6 a.m. 
to ii p.m, there should be nine nursings. 
If he sleeps between 11 p.m. and 6 a.m. 
do not wake him. One feeding at 2.30 
a.m. is required by a few children up to 
the third month ; the great majority, how- 
ever, do better without it. Before and 
after each nursing the mother's nipples 
and the child's mouth should be gently 
washed with a saturated solution of 
boracic acid, using either clean old linen 



Care of the Breasts and Nipples 27 

or absorbent cotton. The nipples should 
be thoroughly dried after the washing. 
Vaseline may then be applied to the 
nipples on old linen or sterile gauze, 
which remains as a dressing until the 
next nursing, when the nipples should be 
washed with a boracic-acid solution before 
the child is put to the breast. This in- 
volves considerable work and is necessary 
only for a week or two, when the nipples 
will be accustomed to their function, and 
the washing with the boracic-acid solution 
will be the only treatment necessary. 

Nursing is often most painful on ac- 
count of cracks and fissures in the nip- 
ples. These are very apt to occur if the 
parts are neglected, and the resulting pain 
when the child nurses is unbearable, 
necessitating sometimes the discontinu- 
ance of the breast-feeding. The baby 
should never be allowed to touch a cracked 
or fissured nipple, and a nipple-shield (see 
Fig. 2) should be used until the parts are 
healed. Some babies take very unkindly 
to the nipple-shield, and often a great deal 
of patience must be exercised before they 



28 Care of the Breasts and Nipples 



can be taught its use. If the shield sug- 
gested does not answer, others may be 
tried. The breast should never be allowed 
to become hard or painful. If the child 
does not take enough to keep the breasts 
soft a breast-pump should be used to 

remove the remain- 
der. For this pur- 
pose, the so-called 
English breast- 
pump (see Fig. 3) 
is the best. With 
the first rush of 
I milk to the breasts 
'£— - 1 it is often very dif- 

FIG. 2. NIPPLE-SHIELD. ficult t0 preVdlt 

hard, painful nod- 
ules from forming in the glands. The 
free use of the breast-pump and massage 
with warm oil, if properly carried out, will 
prevent the formation of an abscess. 

When the breasts are large and pen- 
dulous, a support consisting of a bandage 
firmly applied around the chest will 
often afford much comfort and prevent 
serious trouble. In addition to the use of 




Care of the Breasts and Nipples 29 



the nipple-shield, the cracked nipple should 
be washed with a boracic-acid solution 
after each nursing, and dried, when a 
soothing ointment may be applied on old 
linen ; such an 

ointment, com- " ^ ***. ^ 

posed of ich- 
thyol fifteen 
grains, vaseline 
one-half ounce, 
oxide-of - zinc 
ointment one- 
half ounce, has 
given most sat- 
isfactory re- 
sults. The oint- 
ment should be 
carefully re- 
moved with 
warm sweet-oil 
and the nipple 
washed in alcohol before the next nurs- 
ing. When the fissures are healed, the 
nursing may be resumed, allowing the 
child for a few days to take the nipple 
every second or third nursing, thus 




FIG. 3. ENGLISH BREAST-PUMP. 



30 Weaning 

gradually accustoming the nipples to the 
rough usage. 

WEANING 

When is the nursing baby to be given 
other food, or how long can the breast be 
relied upon to furnish the child its sole 
nourishment ? If the mother, unassisted, 
is able to nourish her infant steadily until 
it is seven months of age, she is doing re- 
markably well. There are very few nurs- 
ing mothers who can pass that period 
without assistance. Perhaps one or two 
bottle-feedings a day may suffice. In 
many cases the milk will fail about the 
seventh month and absolute weaning be 
necessary. Granting, however, that the 
child is thriving on the breast alone, or 
doing satisfactorily on the breast with 
only two daily feedings, at what age 
should the weaning take place ? I have 
known just one mother out of several 
thousand who could nurse her child to the 
child's advantage after twelve months had 
passed. I have seen many pronounced 
cases of malnutrition and rickets due 



The Selection of Milk 31 

directly to prolonged nursing. Indigestion 
and diarrhoea are often the outcome of 
prolonged breast-feeding. 

The weaning in health should begin 
not later than the twelfth month. It is 
best accomplished gradually by substi- 
tuting bottle-feeding for^ nursing, giving 
only one bottle the first day, two the sec- 
ond, three the third, and so on until in a 
week or ten days weaning is complete. 
In case the child is ill we may be obliged 
to wean at once when bottle-feeding is 
substituted for the breast, but the milk 
formula corresponding to his age should 
not be given. To a child six months of age 
give the three-months' formula ; a child 
nine months of a^e should receive the 
six-months' formula. A gradual increase 
to the formula suggested for a child the 
age of the patient may be made if all 
goes well. After the ninth month it is 
often possible to feed from a cup, which is 
then to be preferred to bottle-feeding as a 
substitute for the breast. 

THE SELECTION OF MILK 

The selection of the milk on which the 



32 The Selection of Milk 

baby is to live is a matter of no little im- 
portance. There is a vast difference in 
the quality of the milk on the market Too 
many mothers look upon all milk as be- 
ing of uniform value because it all has a 
similar appearance. While the general 
character of the ftiilk sold has improved 
greatly during the past few years, a great 
deal of that used at the present time is 
unfit for food for a baby. New York 
City mothers should insist that the milk 
used be bottled and sealed at the farm, 
and also insist that it be certified by the 
New York Milk Commission. Milk if 
properly produced is expensive ; it cannot 
be sold for six or eight cents a quart, and 
mothers will have to pay more than this 
if they get a suitable article. The most 
expensive milk will, as a rule, be found 
safest for use. 

THE BOTTLE AND NIPPLE 

The least complicated feeding appa- 
ratus is the best. The oval eight-ounce 
bottle (see Fig. 4) should be used. 
These are without corners and are 



The Bottle and Nippie 



easily cleansed. The straight, black nipple 
is also preferred, for the reason that it can 
be turned inside out and easily 
cleansed. A nipple which can- 
not be turned should never 
be used. At least four nipples 



— rr- W[ 

are needed for a complete out- A 

fit. After using, a nipple should 

be turned and scrubbed with 

a stiff brush and borax water 

— a tablespoonful of borax to 

a pint of water. When not in 

use it should be kept in the 

borax water. Before placing 

it on the bottle it should be 

rinsed in boiled water. The 

nipple should be boiled once FIG - 4. nurs- 

, rp, 11-1- 1 -1 ING-BOTTLE AND 

a day. 1 he blind nipples with- NIPPLE 
out holes are best. Holes of 
the required size may be made with a red- 
hot cambric needle. 

There must be as many bottles as there 
are feedings in twenty-four hours. The 
bottles should be boiled once a day, 
scrubbed with a stiff brush in hot borax 
water and remain in the borax water 



34 Artificial Feeding 

until needed. Before using, they must be 
rinsed with plain boiled water. 

ARTIFICIAL FEEDING 

BOTTLE-FEEDING 

When it is decided that the child will 
have to be nourished by other means than 
the breast, we are obliged to furnish a 
suitable substitute for the mothers milk 
which the child has a right to demand. 
In our selection we must be guided by 
Nature and furnish a food that will corre- 
spond as closely as possible to the moth- 
ers milk. This can be done only by 
the use of cows' milk properly prepared 
and diluted. Proprietary foods and con- 
densed milk furnish very poor substitutes, 
as will be seen under their respective 
headings elsewhere, Cows' milk differs 
from mothers' milk in its most important 
constituents. Good cows' milk contains 
primarily 3.50 to 4 per cent, of fat, 3.50 to 
4 per cent, of proteid and 4 to 5 per 
cent, of sugar. Mother's milk on the 
other hand contains 3.5 to 4 per cent, of 



Artificial Feeding 35 

fat, 1.5 per cent, of proteid and 7 per 
cent, of sugar. It will be seen that 
cows' milk contains more proteid (curd) 
and less sugar than is contained in moth- 
ers' milk. We must endeavor to make the 
proportion of the important constituents 
of cows' milk, — the fat, proteid, and sugar, 
correspond to that of mothers' milk. This 
has given rise to the term modified milk. 
Cows' milk is made to correspond to that 
of the mother by diluting it with water to 
reduce the proteid, and then by adding 
cream and milk sugar to bring up the fat 
and sugar to the required strength. 

The term modified milk is not a good 
one, for the term " modified " does not 
cover all that is done in rendering cows' 
milk a suitable diet, that is, changing it 
to correspond to mothers' milk. We 
would have very little success in infant 
feeding if this were all we did. The 
milk must be adapted to a child's age 
and peculiarities, so that the term -adapted 
milk expresses far better what we wish 
to accomplish. In adapting milk to an 
infant, we must remember that cows'-milk 



36 Artificial Feeding 

proteid is more difficult to digest than 
the proteid of mothers' milk, and that 
frequently a smaller amount of fat must be 
given than is contained in mothers' milk. 
Particularly must these precautions be 
observed in the very young and delicate. 
The gravest error, and one most fre- 
quently made in cows'-milk feeding, is 
that of giving the food too strong, at the 
beginning. In consequence, the digest- 
ive organs are overtaxed, the child vom- 
its, has colic, suffers from constipation or 
diarrhoea, and, of course, cannot thrive ; 
cows' milk is therefore discarded because 
it did not agree with the baby, while it 
was not the milk but the way it was 
given that was at fault In the feeding 
formulas given below, the milk is adapted 
to the various ages of infancy and not to 
the child's condition, as that would obvi- 
ously be impossible. These formulas 
will be found suitable for average infants 
in fair 'health. In the matter of feeding, 
every child is a law unto himself and he 
must be fed individually. For some ba- 
bies the formulas suggested will not 



Artificial Feeding 37 

answer at all. One six-months' child 
may require the nine-months' formula, 
while another may be able to take only 
the three-months' formula. All babies of 
the same age or weight must not be 
expected to thrive on food of exactly the 
same strength. 

It is the duty of the physician to adapt 
the milk to the patient's digestive capa- 
city by giving to each the required pro- 
portion of fat and proteids. The signs 
of successful bottle-feeding are. the same 
as of successful breast feeding : comfort, 
sleep, and an average gain in weight 
of not less than four ounces a week. 
There should be two or three yellow 
stools daily. 

The signs of unsuccessful feeding are 
vomiting, discomfort after feeding, habit- 
ual colic, green, undigested stools, and 
loss, or a very slight gain, in weight. A 
very few children cannot take cows' milk 
in any form. In this class belong those 
who have been badly managed. They 
have taken cows' milk too strong or 
otherwise improperly adapted. They 



38 Artificial Feeding 

may have undergone a series of hys- 
terical changes with various proprietary 
meal foods in the hope that something 
might be found which would agree with 
them. 

In some cases cows' milk of any strength 
produces colic and vomiting or more 
often diarrhoea. These difficult feeding 
cases, whether the result of the delicate 
condition of the child per se or of im- 
proper feeding, require the greatest pa- 
tience on the part of the physician and 
mother. Many of these cases must be 
seen by the physician every day for weeks 
before they can be brought to take a 
suitable diet. Milk must be temporarily 
discarded and substitutes, such as whey, 
diluted cream, barley water or broths, 
should be used. After a short time a 
very small amount of milk may be added 
to the substitute which has been found 
best to agree. Should the milk again 
cause disturbance, condensed milk, — one- 
half to one teaspoonful, — may be given 
with barley water, increasing the amount 
of condensed milk gradually if it is found 



Preparation of the Food 39 



to agree. A wet-nurse is almost indis- 
pensable in some of these cases, 

PREPARATION OF 
THE FOOD 

Two quart-bot- 
tles of the best milk 
obtainable are re- 
quired daily. The 
milk, which is deliv- 
ered at six or seven 
o'clock in the morn- 
ing, is at once 
placed in a refrige- 
rator, where it re- 
mains for a few 
hours, until it is 
convenient to pre- 
pare the food. One 
bottle furnishes the 
milk, the other the 
cream. The bottle 
which is to furnish the milk must be well 
shaken before using, so as thoroughly to 
mix the milk and cream. Skimmed milk 




FIG. 5. THE CHAPIN DIPPER. 



4° Preparation of the Food 

should never be given to an infant. 
Boiled water should always be used. The 
milk sugar should be dissolved in hot water 
before mixing with the milk or cream. 
The cream at the top of the bottle is 
known as " gravity cream." It should 
not be poured off nor should the milk be 
siphoned from under it. The Chapin 
dipper (see Fig. 5) furnishes the best 
means of removing the cream. The 
upper portion of the cream in the bottle 
is richer in fat than that nearer the milk, 
therefore if only the upper dipper or two 
of cream is used it gives a mixture too 
rich in fat. Such being the case, no mat- 
ter how little cream may be required, all 
the cream should be removed from the 
bottle, placed in a clean pint graduate (see 
Fig. 6) which is to be used for all measur- 
ing purposes, and stirred a trifle to make 
it of uniform strength. If the required 
amount of cream cannot be obtained from 
one bottle, another pint or quart of milk 
should be purchased, but cream purchased 
as such should never be used for infant 
feeding. 



Formulas for Feeding 4 1 



FORMULAS FOR FEEDING 
From the first to the third day : 

40 grains of milk sugar, to 1 pint of 
boiled water ; \ to 1 ounce every 2 or 3 
hours. 



From the third to 
the tenth day : 

1 ounce of grav- 
ity cream, 1 ounce 
of milk, 3 20 grains 
milk sugar, pinch 
of salt, boiled 
water to make 1 
pint. 10 feedings 
in 24 hours ; 1 to 
\\ ounces at each 
feeding. 




FIG. 6. ONE PINT GRADUATE. 



From the tenth to the twenty-first day : 

\\ ounces of gravity cream, 3 ounces 
of milk, 1 ounce of milk sugar, pinch of 
salt, water to make 24 ounces. 10 feed- 
ings in 24 hours ; i| to 2 ounces at each 
feeding. 



42 Formulas for Feeding 

From the third to the sixth week : 

3 ounces of gravity cream, 4 ounces of 
milk, \\ ounces of milk sugar, pinch of 
salt, water to make 32 ounces. 9 feedings 
in 24 hours ; 2 to 3 ounces at each feed- 
ing. 

From the sixth week to the third month : 

4 ounces of gravity cream, 5 ounces of 
milk, \\ ounces of milk sugar, pinch of 
salt, water to make 32 ounces. 8 feed- 
ings in 24 hours ; 2\ to 4 ounces at each 
feeding. 

From the third to the fifth month : 

5 ounces of gravity cream, 10 ounces of 
milk, 2 ounces of milk sugar, pinch of salt, 
boiled water to make 40 ounces. 7 to 8 
feedings in 24 hours ; 4 to 5 ounces at 
each feeding. 

From the fifth to the seventh month : 

5 ounces of gravity cream, 15 ounces of 
milk, 2 ounces of milk sugar, pinch of salt, 
water to make 42 ounces. 6 to 7 feedings 
in 24 hours ; 5 to 6 ounces at each feeding. 



Formulas for Feeding 43 

From the seventh to the ninth month : 

6 ounces of gravity cream, 24 ounces of 
milk, 2-1- ounces of milk sugar, pinch of salt, 
water to make 48 ounces. 6 feedings in 
24 hours ; 6 to 8 ounces at each feeding. 

From the ninth to the twelfth month : 

7 ounces of gravity cream, 35 ounces of 
milk, 2 ounces of lime water, 2\ ounces 
of milk sugar, water to make 56 ounces. 
6 feedings in 24 hours ; 7 to 9 ounces at 
each feeding. 

After the seventh month, from one to 
two tablespoonfuls of oatmeal, barley, or 
wheat jelly should be added to each 
feeding. 

After the twelfth month, plain cows' milk 
may be given with the cereal jelly in 
addition to the other articles of diet sua-- 
gested for a child one year old. (See 
page 49.) 

The cereal jellies are made by boiling 
the cereal selected for three hours. It 
will be noticed that considerable latitude 
is allowed as to the amount of food which 



44 Formulas for Feeding 

is to be given at one feeding. This is be- 
cause of the difference in the capacity of 
individual children. After the third month 
the midnight feeding should be discon- 
tinued. Seven feedings will be sufficient, 
the first at 6 a.m., and the last at 10.30 
or 11 p.m. Between 11 p.m. and 6 a.m. 
the child should sleep. Babies are easily 
broken from the night bottle by substi- 
tuting a bottle of boiled water or a milk 
mixture greatly diluted with water. The 
child soon discovers that this is not worth 
waking for. As a result of a full night's 
rest the digestive organs are better able 
to do their work, the appetite is increased 
and a larger amount of food may be given 
at each feeding. 

The foregoing formulas will be found 
useful for the majority of average well 
babies. Those with pronounced digest- 
ive peculiarities should have the food 
especially adapted. 

When the milk does not agree the cause 
must be discovered. The food as a whole 
may be too strong, when there will be in- 
digestion and colic, and possibly diarrhoea 



Formulas for Feeding 45 

and vomiting. If the food contains too 
much cream there will be looseness of the 
bowels, and colicky stools, with considera- 
ble straining ; there is apt to be regurgi- 
tation also. The sugar is rarely a cause 
of trouble, an indication of excess being 
the eructation of gas and a regurgitation of 
sour, watery material. It is compara- 
tively rare, however, for the fat and sugar 
to cause any disturbance if they are 
given with any degree of intelligence ; but 
the proteid, — the curd-forming element 
in cows' milk, — often gives us no end 
of trouble. Many infants, as previously 
stated, are able to digest only a very weak 
cows'-milk proteid ; consequently at the 
beginning of cows'-milk feeding, when, as 
is often the case, too much milk is used, — 
too strong a food given, — the result is 
always disastrous. This, with too fre- 
quent feeding and night feeding, comprise 
the chief errors made in cows'-milk feed- 
ing ; in fact, they are the cause of more 
bottle-feeding failures than all other fac- 
tors combined. Excess of cows'-milk pro- 
teid is the cause of habitual colic, and is an 



46 Sterilization of Milk 

important element in habitual constipa- 
tion. Chronic indigestion, as shown by 
vomiting, and undigested green stools are 
most frequently due to this cause. We 
frequently see children who cannot take 
cows' milk in any form ; they must be 
given cream diluted either with plain 
boiled water, or with a cereal water to 
which milk sugar or cane sugar has been 
added. 

STERILIZATION AND PASTEURIZATION 
OF MILK 

Some confusion exists in the minds 
of mothers as to the significance of 
the terms sterilization and pasteuriza- 
tion. Milk is said to be sterilized when 
it has been heated to the boiling-point, 
2 12° F. and kept at this point for thirty 
minutes. 

Pasteurized milk is milk heated to 155 
F. and kept at this temperature for thirty 
minutes. In heating the milk we have 
two objects in view : to kill the harmful 
micro-organisms which it may contain, 
and to keep the milk sweet for a longer 



Sterilization of Milk 47 

time than would otherwise be possible. 
The degree of heat to which the milk is 
subjected should depend upon the season 
of the year, the source of the supply, the 
age of the milk and the digestive capacity 
of the child. The more the milk is heated 
the more difficult of digestion it becomes, 
and the more liable it is to produce con- 
stipation ; so that, other things being 
equal, the less we heat the milk the better 
the nourishment we furnish to the child. 
In country districts where the cows are 
known to be healthy, and the milk clean 
and fresh, heating is unnecessary. In 
cities and large towns, where the source 
of the milk is unknown, and where it is 
from twenty-four to thirty-six hours old 
when it reaches the consumer, heating to 
a moderate degree is a safe procedure at 
any time of the year. Pasteurizing the 
milk kills most of the dangerous germs 
without materially affecting the digesti- 
bility, or changing the taste of the milk. 
Among the intelligent and cleanly I ad- 
vise the pasteurization of milk ; among 
the ignorant poor and the careless, — such 



48 



Sterilization of Milk 



as we frequently see in out-patient work, 
the milk should be boiled, particularly 
during the 
hot months. 

The pas- 
teurization 
of milk is 




FIG. 7. FREEMAN PASTEURIZER WITH BOTTLE RACK 
REMOVED. 

best accomplished by the use of the 
Freeman Pasteurizer (see Fig. 7). 

Directions for use are furnished with 
the Pasteurizer. 

If for any reason the Freeman Pasteur- 






The Diet for a Child 49 

izer cannot be used, the milk may be 
heated in a double boiler. If this is not 
at hand an ordinary agate basin may be 
used. The vessel should be placed over 
a slow fire, with a milk thermometer held 
in the mixture. When the thermometer 
registers 1 70 , remove the milk from the 
fire and pour it into as many bottles as 
there are feedings in the twenty-four 
hours. Absorbent cotton should be used 
for stoppers. The bottles should be 
cooled rapidly by placing them in cold 
water. The Freeman Pasteurizer should 
always be used if possible, for the reason 
that it saves much trouble, the tempera- 
ture to which the millc is heated is uni- 
form, it requires no manipulation of the 
milk after it has been prepared and heated, 
and there are no chances of the contami- 
nation of the milk from the air. 

THE DIET FOR A CHILD FROM ONE 
TO TWO YEARS OF AGE 

At the completion of the twelfth month 
the average well-regulated breast baby 
should be weaned, and other nourishment 



50 The Diet for a Child 

given. If bottle-fed, he should receive 
more than the milk and cereals with which 
most children are fed. The food suitable 
for the second year of life and the method 
of its preparation and administration are 
subjects upon which the masses are most 
profoundly ignorant. A few children at 
this period of life are underfed, but the 
great majority are overfed, and carelessly 
given, at improper intervals, unsuitable 
food, wretchedly cooked. Summer diar- 
rhoea finds its greatest number of vic- 
tims among those children over twelve 
months of age who have been carelessly 
fed. The dreaded " second summer " 
robs many homes because of ignorant or 
careless parents. The second summer 
managed properly is hardly more danger- 
ous than any other summer during the 
early years of a child's life. It is almost a 
universal custom when the child is weaned 
or given something other than a milk diet, 
to allow him " tastes " from the table. 
Very often these tastes comprise the en- 
tire dietary of the adult. Milk is often- 
times the only suitable article of diet that 






The Diet for a Child 51 

is given. Afterward not only is the 
other food selected unsuitable, but it is 
given irregularly, and supplemented by 
crackers kept on hand for use between 
meals. During the hot months the 
gastro-intestinal tract is less able to bear 
such abuse and the child becomes ill. 
Usually when the twelfth month is com* 
pleted I give the mother a diet schedule, 
with instructions to begin gradually with 
the articles allowed, in order to test the 
child's ability to digest them. Every new 
article of food should be carefully pre- 
pared and given at first in very small 
quantities. All meals are to be given 
regularly, with nothing between meals. 
With many children this expansion of the 
diet list is attended with considerable diffi- 
culty. They are thoroughly satisfied with 
the milk, and refuse all other forms of 
nourishment. In such cases time, and 
patience are necessary at the feeding time. 
The more solid articles of diet should be 
given first, and the milk kept in the 
background. 

Among the underfed seen at this period 



52 The Diet for a Child 

of life are those who were nursed too 
long or those who were kept for too long 
a time upon an exclusive milk diet. A 
great majority of the cases of malnutri- 
tion of the second year are seen in the 
exclusively milk-fed. They are pale, soft, 
flabby, badly nourished children. 

The following is a diet schedule which 
I have employed for several years. Each 
mother is instructed to select, from the 
foods allowed, a suitable meal. 

From the twelfth to the fifteenth month : 
five meals daily. 

7 a.m. Oat meal, barley or wheat jelly, 
one to two tablespoonfuls in eight ounces 
of milk. The jelly is made by cooking 
the cereal used for three hours and then 
straining through a colander. 

9 a.m. The juice of one orange. 

ii a.m. Scraped rare beef, — one to 
three teaspoonfuls, or soft-boiled cgg y a 
piece of zwieback and a half-pint of milk. 

3 p.m. Beef, chicken or mutton broth 
with stale bread broken into it. Six 
ounces of milk, if wanted. 



The Diet for a Child 53 

6 p.m. Two tablespoonfuls of cereal 
jelly in eight ounces of milk ; a piece of 
zwieback. 

9.30 p.m. A tablespoonful of cereal 
jelly in eight ounces of milk. 

From the fifteenth to the eighteenth month: 
four meals daily. 

7 a.m. Oat meal, barley or wheat jelly, 
one to two tablespoonfuls in eight ounces 
of milk. 

9 a.m. The juice of one orange. 

11 a.m. A soft-boiled egg mixed with 
stale bread crumbs. One tablespoonful of 
scraped rare beef mixed with dry bread 
crumbs and moistened with beef juice. 
A drink of milk ; zwieback or bran bis- 
cuit, or a crust of bread. 

3 p.m. Mutton, chicken or beef broth, 
with stale bread broken into it. Custard, 
corn starch, or plain rice pudding ; stewed 
prunes, baked apples, or apple sauce. 

6 p.m. Two or three tablespoonfuls of 
cereal jelly with eight to ten ounces of 
milk. 



54 The Diet for a Child 

From the eighteenth to the twenty-fourth 
month : four meals daily. 

7 a.m. A soft-boiled egg y the heart of 
a lamb chop. Farina, hominy, or oat meal 
with equal parts of milk and cream. A 
drink of milk, bran biscuit and butter, 
or stale bread and butter. 

9 a.m. The juice of one orange. 

ii a.m. Rare beef, minced or scraped, 
spinach, asparagus tops, stewed tomatoes 
strained, mashed cauliflower, baked apple 
or apple sauce. A drink of milk, stale 
bread and butter. 

After the twenty-first month, baked 
potato, and well-cooked string beans may 
be given. 

3 p.m. Chicken, beef or mutton broth, 
with stale bread broken into it, custard, 
corn starch, or plain rice pudding, stewed 
prunes, a drink of milk, bran biscuit and 
butter, or stale bread and butter. 

6 p.m. Rice and milk, hominy and 
milk, farina and milk or stale bread and 
milk. 



The Diet for a Child 55 

THE DIET FOR A CHILD FROM TWO TO 
THREE YEARS OF AGE 

THREE MEALS DAILY 

The mother will select suitable meals 
from the following menu : 

Breakfast (Seven to eight o'clock). — 
Wheatena, oatmeal, hominy, cracked 
wheat (each cooked three hours), with a 
little sugar, and equal parts of milk and 
cream. 

A soft-boiled egg, a lamb chop, stale 
bread and butter, bran biscuit and butter ; 
a drink of milk. 

At ten o'clock, the juice of one orange 
may be given. 

Dinner (Twelve o'clock). — Strained 
soups and broths, rare steak, rare roast 
beef, poultry, fish, baked potato, peas, 
string beans, mashed cauliflower, strained 
stewed tomatoes, spinach, asparagus 
tips, bread and butter ; a glass of milk. 
(For dessert : Plain rice pudding, plain 
bread pudding, stewed prunes, baked 
or stewed apple, custard or corn- 
starch.) 



56 The Diet for a Child 

Supper (Five-thirty to six o'clock). — 
Rice and milk, farina and milk, bread 
and milk, bread and butter, or bran biscuit 
and butter. Twice a week, custard or 
cornstarch may be given or a tablespoon- 
ful of plain vanilla ice-cream. 

As a rule three meals answer best at 
this period. With three meals a child 
has a better appetite and much better 
digestion and consequently thrives far 
better than one whose stomach is kept 
constantly at work. Some children, how- 
ever will require a luncheon at 3 or 
3.30 p.m., and will not do well without 
it. This is apt to be the case with deli- 
cate children, particularly those under 
two and one-half years of age. If food is 
necessary at this hour, a glass of milk and a 
Graham biscuit will answer every purpose. 
Children recovering from serious illness 
will also require more frequent feeding. 

THE DIET FOR A CHILD FROM THREE 
TO SIX YEARS OF AGE 

The mother will select suitable meals 
from the following menu : 



The Diet for a Child 57 

Breakfast, — Cracked wheat, wheatena, 
hominy, oatmeal — each cooked three 
hours. They may be served with equal 
parts of milk and cream and a little sugar. 

A soft-boiled egg y omelet, scrambled 
egg, chop, bread and butter, bran biscuit, 
a glass of milk, one orange, one-half 
dozen stewed prunes. 

Dinner. — Plain soups of all kinds. 

Rare roast beef, steak, poultry, fish, 
potatoes stewed with milk, or baked. 

Peas, beans, strained stewed tomatoes, 
mashed cauliflower, spinach, asparagus 
tips, bread and butter, a cup of milk. 
(For dessert : Rice pudding, plain bread 
pudding, custard, tapioca pudding, stewed 
prunes, baked apple with cream. Raw 
apples, or uncooked pears and cherries, 
may be given after the fourth year.) 

Supper. — Rice and milk, farina and 
milk, bread and milk, scrambled egg twice 
a week, custard or cornstarch, each once 
a week, ice-cream once a week, bread and 
butter, a glass of milk. 

When the child has eggs for breakfast, 
they should not be repeated in any form 



58 How the Child Should be Fed 

for supper. Red meat should be given 
but once a day. When the child has a 
chop for breakfast, he should have poul- 
try or fish for dinner. 

HOW THE CHILD SHOULD RE FED 

In the foregoing articles on feeding, 
the author has endeavored to instruct 
mothers as to the nature of the food 
required by the growing child, and the in- 
tervals at which food should be given. 
This, however, is not all that she should 
know and practise in this line. A 
child should never dine with adults until 
he can have adult diet. It is a species 
of cruelty to expect a hungry child to sit 
at the table, see and smell the fragrant 
dishes, and be forced to content himself 
without complaint with milk toast and 
mush. The author recalls this custom as 
a cause of many tears, disputes, and fistic 
encounters with attendants, which formed 
no small part of the daily routine of his 
early life. 

In feeding, the spoon or fork must 
come in contact only with the food and 



How the Child Should be Fed 59 

the child's mouth ; when not in use it 
should be allowed to rest on the clean 
table-cloth. If it falls to the floor by 
accident it should be washed in boiling 
water before using it. Under no cir- 
cumstances should a feeding utensil be 
allowed to come in contact with the lips 
of the nurse or mother ; time and again 
I have seen mothers and nurses sip or 
swallow the first teaspoonful of the food 
which is to be given, to determine if it is of 
the proper temperature. At other times, 
when the food is not particularly attrac- 
tive to the child, they will place the spoon 
in their mouths as though they intended 
to take it themselves, and exclaim that it 
is " so good." Others will remove from 
the spoon with their own lips adhering 
particles of food. 

There are few more reprehensible 
practices than the foregoing, and if 
mothers knew the dangers to which their 
children are thus subjected they would 
not for one instant tolerate them. Any 
one of the many forms of pathogenic 
bacteria may be most readily transferred 



60 Condensed Milk 

to the mouth of the child in this way. It 
is unquestionably a means of infection 
with tuberculosis, diphtheria, and syphilis. 
The germs of tuberculosis and diphtheria 
are frequently found in the mouths of 
perfectly healthy adults. They cause no 
symptoms of disease because of the nor- 
mal power of resistance of such adults. 
The resisting powers of the child, how- 
ever, to these micro-organisms are very 
slight, and when they are carried to the 
delicate mucous membrane of the infant's 
mouth and throat they thrive actively, 
the child develops diphtheria or tuber- 
culosis, and the family grieve and wonder 
how the child could ever have contracted 
the disease. 

CONDENSED MILK 

Condensed milk should • never be se- 
lected as a food for a baby if the mother 
can afford to buy cows' milk and can learn 
how to prepare and care for it. The 
child' s natural food is the mother's milk ; 
this is what he has a right to demand. If 
mothers' milk cannot be furnished we 



Condensed Milk 61 

must give a substitute which will provide 
the baby with the nourishment contained 
in mothers' milk. Analyses by many 
chemists of thousands of samples of good 
mothers' milk show that it contains ap- 
proximately 3.5^ to 4^ of fat, 1.5$ of 
proteid and 7% of sugar. Condensed 
milk, diluted one to twelve, t. e., one part 
condensed milk to twelve parts of water, — 
the strength taken by a three-months-old 
child, — will give a food containing .5$ of 
fat and .6% of proteid, and 4.% of sugar. 
Compare these figures with the amount 
of fat, sugar, and proteid contained in 
mothers' milk and it will readily be seen 
that the baby is not getting nearly as 
much nourishment as Nature would fur- 
nish him. If the mixture, using the con- 
densed milk, is made in the proportion of 
one part condensed milk to eight parts of 
water — the proper strength for a six- 
months-old child — there will still be less 
than if of fat, and a lower proteid than 
in mothers' milk. Condensed milk has 
its uses, however. Many mothers can- 
not afford to buy fresh cows' milk. Some 



62 Condensed Milk 

have no refrigerator or ice-box in which 
to keep it. Condensed milk, on account 
of the cane sugar which has been added 
to it, will remain fresh for two or three 
days after it has been opened. It is a 
most inexpensive means of feeding the 
baby. Further, its preparation is exceed- 
ingly simple, and many mothers are too 
ignorant to appreciate the importance of 
the careful preparation of cows' milk. 
That magnificent charity, the Straus milk 
laboratory, which furnishes properly pre- 
pared milk at a minimum price, is available 
for comparatively few of the city's poor. 

Condensed milk is for many an ab- 
solute necessity ; but though children 
manage to live on it, they never thrive 
satisfactorily. They all show evidence of 
some degree of rickets, unless fat in some 
form, e. g. y cod-liver oil or cream, is given 
in addition, to supplement the food; and 
very few children can take cod-liver oil 
during- the summer months. There is 
another class of children for whom con- 
densed milk has served us well at various 
times. They are the young, delicate 



Condensed Milk 63 

infants, with very weak digestive pow- 
ers. Their mothers cannot nurse them, 
wet-nurses are impossible, and, for some 
reason, the smallest amount of cows' 
milk, most carefully adapted, cannot be 
tolerated ; a single teaspoonful of milk or 
cream in two ounces of plain water, whey, 
weak milk-sugar water, or barley water 
produces colic and diarrhoea. I have suc- 
cessfully fed several of these infants on a 
mixture consisting of one part of con- 
densed milk and twelve parts of water. 
I prefer the unsweetened variety. For 
some unexplained reason these children 
digest the condensed milk without any 
inconvenience and do fairly well for a few 
weeks, when the secretion of the digestive 
juices will be better established and a 
weak adapted cows'-milk mixture will be 
borne. Condensed milk is also useful in 
travelling. During journeys by land and 
sea, condensed milk with boiled water will 
furnish satisfactory food for a limited 
time at a minimum amount of trouble. 

The following formulae may be found 
of service to those who for any reason are 



64 Proprietary Foods 

forced to use a temporary substitute for 
adapted cows' milk : 

P'irst month of life : i part of condensed milk to 
13 of water. 

Second month : 1 part of condensed milk to n 
of water. 

Third month : 1 part of condensed milk to 10 of 
water. 

Fourth to sixth month : 1 part of condensed 
milk to 8 to 10 of water. 

After the sixth month : 1 part of condensed milk 
to from 6 to 10 of water. 

These are all maximum strengths ; for 
many cases a greater dilution will be re- 
quired. If a child is fed on condensed 
milk for a longer time than a week, cream 
or cod-liver oil should be given,- — each 
feeding being supplemented by from one- 
half to two teaspoonfuls of cream, or from 
ten to twenty drops of pure cod-liver oil. 

PROPRIETARY FOODS 

The baby foods on the market, by 
chemical analysis and clinical observation, 
are shown to be most inadequate substi- 
tutes for mothers' milk. Mothers' milk 
contains 3.50% to \°/ of fat, 1.5$ of pro- 



Proprietary Foods 65 

teid and y% of sugar. There is not a pro- 
prietary food on the market which, when 
prepared for use for a child from three 
to six months of age, contains even 1% 
of animal fat ; they are also very deficient 
in animal proteids. It will thus be seen 
what inefficient substitutes we are dealing 
with. Those which are to be dissolved 
in water should never be given an infant 
as a steady diet. With a few it is stated 
on the package that they are to be dis- 
solved in milk, cream, and water. The 
milk, cream, and water are directed to be 
given in such proportion that a satisfac- 
tory diet will be supplied. The addition 
of the proprietary food furnishes the 
sugar, the child thrives and the proprie- 
tary food gets the credit for the nourish- 
ment supplied by the milk and cream. 
The baby is known as such and such a 
proprietary food baby. 

Those foods which are used with water 
alone are very easy of preparation and 
this is very apt to prejudice mothers and 
nurses in their favor. 

In selecting a food for the baby it 



66 Peptonized Milk 

must be kept in mind that it is nourish- 
ment which we seek to give the child, and 
the composition of mothers' milk must be 
our guide, for this is what Nature in- 
tended the child should have. When 
this cannot be furnished, we must approx- 
imate to it as nearly as possible by the 
use of cows' milk and cream properly 
diluted and prepared. 

Proprietary foods are sometimes useful 
in cases of illness ; as a rule they are 
easily digested and may aid us as a means 
of nourishment until more substantial 
food can be taken. 

PEPTONIZED MILK 

Milk is said to have been peptonized 
when it has been subjected to the action 
of a digestive ferment, i. e., pre-digested. 
Milk thus treated may be " peptonized," 
but it is not pre-digested to the extent of 
being of any value to the child who can- 
not digest the curd of cows' milk. The 
peptonizing of milk is theoretically indi- 
cated and should be of value in treating 
those cases referred to under the head of 



Milk for Travelling 67 

"Malnutrition among Bottle-Fed Infants.' 
— those who cannot digest the smallest 
quantity of cows -milk proteid. In these 
cases I have used the various peptonizing 
preparations time and again without any 
success whatever. If peptonized milk 
were of any value it would be of great 
service in feeding these infants Children 
who do not need peptonized milk do well 
on it. 

MILK FOR TRAVELLING 

How to prepare and care for the baby s 
food preparatory to and while travelling, 
is a puzzling question among mothers. 
It is eminently desirable that no change 
be made from the milk regularly used, 
but this will not be fit for use unless it 
is kept on ice, regardless of the season. 
The Walker-Gordon Laboratory of New 
York City furnishes at a trifling expense 
small ice-boxes which contain sufficient 
space for four days milk supply, and which 
can conveniently be carried on cars and 
boats. They also have a larger box with a 
capacity of twelve quarts, which may be 



68 Diet During Illness 

used for an ocean voyage. The small boxes 
will need refilling once or twice a day 
with ice, which can easily be secured from 
porters or other attendants on boats and 
trains, The larger boxes for ocean voy- 
ages, if packed with ice and placed in the 
cold-storage room in the vessel, will not 
need repacking during the trip. The 
milk prepared for a journey longer than 
twenty-four hours should be boiled twenty 
minutes and kept at a temperature of 
40 F. , or lower. When this is done 
the milk will be safe for use for ten 
days. Those who ? for any reason, cannot 
avail themselves of milk thus preserved, 
will find in condensed milk a fairly good 
substitute. If kept covered, a can of con- 
densed milk will remain sweet for three 
days after being opened. Formulae suited 
for the various months of infancy will be 
found under the heading 4< Condensed 
Milk" page 64. 

DIET DURING ILLNESS 

During even a very slight illness in 
a young infant or * run-about " child, its 



Diet During Illness 69 



*& 



digestive capacity is greatly diminished. 
This is a fact but little appreciated or if 
appreciated, rarely acted upon Infants 
ill with pneumonia, scarlet fever, measles 
or summer diarrhoea, are usually given 
their accustomed diet, if they will take it 
If the patient is breast-fed he is nursed as 
often and as long as in health. If bottle- 
fed, his food is of the usual strength and 
quantity. Many times children with fever 
and consequent thirst are given more 
milk than when well. In this way severe 
gastro-intestinal disorders are often started 
which add an unpleasant, if not dangerous 
complication to the existing disease. 

In severe illness, with fever, the strength 
of the food should be reduced from one- 
third to one-half, by the addition of boiled 
water. If the baby is taking six ounces 
of an adapted milk, we should throw out 
three ounces of the milk mixture and add 
three ounces of water, so that the quantity 
remains the same. In an illness of less 
severity the dilution should be propor- 
tionately smaller. If the child is thirsty, 
boiled water may be given at any time. 



70 Vomiting 

If the patient is a nursing baby, the time 
allowed for the nursing should be re- 
duced and water given by teaspoon or 
bottle between the nursings. 

In summer diarrhoea, the milk must be 
discontinued upon the appearance of the 
first symptoms and other nourishment 
substituted. Children of the " run-about "; 
age may be given milk, broths, and gruels 
during any severe illness, except one in- 
volving the gastro-intestinal tract. 

VOMITING 

A sudden attack of vomiting may usher 
in any serious illness, with fever. Thus, 
it may be the initial symptom of pneu- 
monia, scarlet fever, or meningitis. By 
far the most usual cause, however, will 
be found intimately connected with the 
stomach, usually an acute attack of in- 
digestion. Bottle-fed children furnish the 
greatest number of patients, as these 
children are almost always overfed, and 
more or less badly fed. With the onset 
of a sharp attack of vomiting, particularly 
if it occurs during hot weather, the milk 



Habitual Vomiting 7 1 

diet should immediately be discontinued. 
Small quantities of boiled water, one- 
half to two ounces of barley water or 
rice water, or plain broths may be given 
every hour or two In the obstinate 
cases, quite a period of rest should be 
given the stomach. From twenty-four to 
thirty-six hours will often be necessary 
before the child will be able to retain 
even a teaspoonful of water. Xo milk 
should be given until the vomiting has 
ceased for at least two days. When the 
milk is resumed it should be diluted five 
or six times with water and at first only 
a small quantity of the mixture given. 
In many of these cases a stomach wash- 
ing will speedily correct the trouble. If 
the stomach bears the food well its 
strength may gradually be increased by 
an additional half-ounce of milk daily 
until the former diet is resumed. 

HABITUAL VOMITING 

Many children regurgitate or vomit a 
portion of every feeding This means 
one thing always, — the child is overfed. 



72 Malnutrition and Marasmus 

He is given the food too strong or the 
amount is greater than his capacity. In 
either case the stomach relieves itself. 
Many of these children who regurgitate 
after each feeding thrive finely in spite of 
the loss. Enough is retained for their 
nourishment, and they gradually become 
accustomed to the strong food and no 
serious harm results. Such a stomach, 
however, is liable to behave very badly 
during hot weather. During any illness, 
in fact, which taxes the patient's strength, 
the disordered stomach stands ready to 
furnish an unpleasant complication. 

The treatment of habitual vomiting in 
the bottle-fed is by a suitable adaptation 
of the food. Among the breast-fed the 
breast-milk will have to be examined and, 
if found unsuitable, corrected if possible. 
If too frequent nursings or night nurs- 
ings have been allowed they should be 
discontinued. 

MALNUTRITION AND MARASMUS 

By malnutrition we understand that 
condition in which a child for some reason 



Malnutrition and Marasmus 73 

fails to gain in weight or loses steadily 
for a considerable period of time. Cases 
present all degrees of severity, from 
those in which there is merely a tempo- 
rary loss of weight, to those of an ex- 
treme degree of malnutrition, which latter 
condition we term marasmus. A maras- 
matic infant presents one of the most 
pitiful pictures we are called to look 
upon : the dry skin drawn tightly over 
the fleshless bones, the sunken eye, the 
distended abdomen, the anxious, tired 
expression, and the whining cry furnish a 
picture of starvation so pathetic that only 
those hardened by long familiarity with 
such cases can look upon them unmoved. 
When the history of such infants has 
been looked into it will be learned that 
errors in feeding contributed largely to 
bringing them to their woful condition. 
Many of these children came into the 
world strong and vigorous, the mothers 
were unable to nurse them, and the food 
selected did not agree with them. Cows' 
milk, perhaps, was given, unsuitably 
adapted, — it usually is given too strong to 



74 Malnutrition and Marasmus 

young infants, — at any rate it disagreed, 
and the proprietary meal foods were 
brought into use, one after another, as 
they were suggested by well-meaning 
friends, each to do its share of damage 
and in turn to be discarded. The stomach 
bore the ill-usage for a time, but soon 
became so disturbed that the digestion of 
rational food was out of the question. 
Many of these children finally reach the 
point where pre-digested foods fail to be 
assimilated ; such cases, of course, are 
hopeless. 

It is a source of amusement oftentimes 
to note the assurance with which laymen 
will advise a mother that such and such a 
food is the only one for the baby, when 
they possess neither the intelligence nor 
the training necessary to judge of the 
child's digestive peculiarities or capacity ; 
in fact, they know no more of the child's 
requirements or the chemical composition 
of the food suggested, or even what should 
be the composition of the baby's food, 
than does the unfortunate babe itself. 

If there is inherited weakness, or a low 



Malnutrition and Marasmus 75 

vitality from any cause, the downward 
course may be very rapid. There are 
two or three weeks of suffering, and then 
the end. If seen before the vital powers 
are at too low an ebb, these children, by 
very careful and intelligent management, 
can be saved. They should be handled 
only when necessary for dressing and 
bathing. The nourishment given must at 
first be very weak, and its effects carefully 
watched from day to day, the strength 
and amount of the food being increased 
or decreased, as may be found necessary. 
A brine bath should be given daily, — a 
tablespoonful of salt to a gallon of water. 
The temperature of the water should be 
ioo° to 105 F. The child should remain 
in the water ten minutes, being rubbed 
well with the hand while in the water. 
When removed, it should be placed in a 
large bath towel and dried quickly. When 
dry, rub one tablespoonful of unsalted 
lard or goose-grease into the skin. Flan- 
nel should be worn next to the skin ex- 
cept during very warm summer weather. 
Marasmatic children when sleeping 



76 Malnutrition and Marasmus 

should not be allowed to remain long in 
one position ; they should frequently be 
turned from the back to the side, and 
from one side to the other. A hot-water 
bottle to the feet will often be necessary 
when sleeping. To a child suffering from 
malnutrition, fresh air is as indispensable 
as food. During the warm weather if 
he can be protected from the sun the 
child should be kept out of doors from 
morning until night. During the entire 
year he should sleep with the window 
open. During the winter months he 
should be taken out of doors for at least 
one-half hour every pleasant day. When, 
on account of the inclement weather or ex- 
cessive cold he cannot go out, he should 
be dressed as for the daily outing, taken 
into a room all the windows of which have 
been open for at least one-half hour ; here, 
placed in a baby-carriage, and warmly 
covered, with a hot-water bottle at his feet, 
he is allowed to enjoy the fresh air for 
an hour or two each day. This brightens 
the eye, brings color to the cheek, and an 
invigorated baby returns to the nursery. 



Summer Diarrhoea 77 

SUMMER DIARRHCEA 

Summer diarrhoea is the cause of more 
deaths among young children in our large 
cities than any other one factor. So 
prevalent and so dangerous an illness 
should be better understood by the laity 
than is the case at the present time. Ev- 
ery illness of this nature must be consid- 
ered as a case of poisoning. The vomiting 
and diarrhoea are conservative efforts on 
the part of Nature to get rid of the offend- 
ing material. The poisoning may result 
from direct infection. It may be due 
to bacteria-laden milk, unclean feeding 
apparatus, or to any means whereby poi- 
sonous germs find entrance into the gas- 
trointestinal tract. 

There may also be an indirect infection 
or self-poisoning — an auto-intoxication. 
Heat plays an important part in these 
cases. The child is greatly depressed ; the 
digestive processes are not properly car- 
ried on — the milk taken from the breast 
or bottle is not acted upon by digestive 
juices of the usual strength and volume ; 
decomposition takes place ; poisons are 



78 Summer Diarrhoea 

generated and absorbed, producing fever 
and prostration ; the intestine endeavors 
to empty itself of the offending material 
and diarrhoea results. 

Cholera infantum, inflammation of the 
bowels, dysentery, — all very bad terms 
but in common use, — are due primarily 
to the causes above mentioned. Such 
being the nature of summer diarrhoea, 
the duties of the mother in such cases 
should be clearly understood. The in- 
testine must be relieved of as much as 
possible of the material which is causing 
the trouble. For this purpose give one 
teaspoonful of castor-oil, and nourishment 
which will not furnish a fertile soil for 
the growth of bacteria. For this reason 
milk must be stopped with the first symp- 
tom of the trouble. The mother will 
never make a mistake in these cases, in 
fact, many a life will be saved by an im- 
mediate dose of castor-oil and by promptly 
stopping the milk diet before the physi- 
cian arrives. Milk, in addition to furnish- 
ing a medium for the growth of bacteria, 
forms into tough curds which must pass 



Summer Diarrhoea 79 

the entire length of the intestinal tract, 
exciting a very active peristalsis, causing 
pain and an increase in the number of 
passages. The diet substituted for milk 
should consist of some cereal water plain 
or dextrinized 1 ; either barley, wheat, or 
rice may thus be used ; broths, whey, or 
substances of like nature may be given 
alternately or combined with the cereal 
waters. Salt should be added to the 
barley water if it is given plain. I prefer 
to give one or two ounces of chicken or 
mutton broth with the barley-water. A 
teaspoonful of sherry wine or one tea- 
spoonful of liquid peptonoids may be 
added to the barley-water. Broths must 
be given in small amounts, as not infre- 
quently they have a decidedly laxative 
effect, 

It is not advisable to give one food 
continuously, as the child will tire of it 
The addition to the barley-water of one 
of the substances suo^orested w [\\ so 
change its taste that, if necessary, the 

1 Dextrinization is best accomplished by the use of cereo — 
a diastatic preparation made for this purpose. 



So Summer Diarrhoea 

diet may be continued for several days. 
The quantity should correspond to the 
amount of food taken in health, but the 
intervals between feedings should be 
shorter, — every two hours if practicable. 
For instructions for cooking the cereal 
water, see Formula, pages 261-262. 

A patient is not to be considered out of 
danger nor should the milk diet be re- 
sumed until the stools are normal and 
not over two or three daily. In many 
cases milk must be excluded for two or 
three weeks. When it is resumed care 
must be exercised in not giving too 
strong a mixture ; many a relapse is due 
to this error. The first day not over 
one-quarter ounce of milk should be 
given in each feeding of the barley- 
water. If this causes no disturbance 
one-half ounce may be given the next 
day, increasing from one-quarter to one- 
half ounce daily, if there is no return of 
the diarrhoea, until the customary strength 
is reached. Many children will not be 
able to digest nearly as strong a mixture 
as they were taking before their illness, 



Summer Diarrhoea 81 

and the diluted milk mixture will have to 
be supplemented by the use of dextrin- 
lzed cereal gruels, cereal jellies, scraped 
beef, the white of an egg, and other easily 
digested substances. Every year I have 
patients who, after such an attack, cannot 
take a particle of milk without harm 
until the autumn is well advanced. 

Washing out the bowels once or twice 
a day is also very helpful in the treatment 
of these cases if the stools contain any 
blood or much mucus. This is done as 
follows : A No. 14 soft-rubber English 
catheter, one that will not bend upon 
itself, if properly used, is attached to a 
fountain syringe. The bag should be 
held three feet above the patient, who 
should lie on the left side with the legs 
well drawn up. The tip of the well-oiled 
catheter is passed into the rectum a dis- 
tance of two inches, when the water is 
allowed to pass in slowly. The water will 
distend the parts and facilitate the further 
introduction of the tube. Press the folds 
of the buttocks together until the colon 
is filled. This, in a child eighteen months 



82 Summer Diarrhoea 

of age, will require from twenty-four to 
thirty ounces of water. When not less 
than one pint has passed in allow the 
water to pass out alongside the tube. 

A word regarding the prevention of 
summer diarrhoea. It is not enough that 
the child be given properly prepared pas- 
teurized or sterilized milk or breast-milk, 
— he must be made comfortable during the 
hot weather. The clothing should be of 
the lightest. On very hot days, if in the 
country, he should be kept in the open 
air, in the shade ; if in the city, the 
coolest room in a house or an apart- 
ment is far better than the dusty streets. 
Whether in the city or country, on very 
hot days two or three fifteen-minute 
spongings with water at 6o° F will add 
greatly to the child's comfort 

Further, we know that the digestive 
capacity is lessened during the heated 
term, and the milk should be reduced in 
strength from one-quarter to one-third, 
adding boiled water to take the place of 
the milk removed 

As infection may be carried to the 



Bathing 83 

feeding utensils by the hands of the nurse 
or mother, she should always wash them 
most carefully with soap and water before 
handling bottles or nipples, or preparing 
the infant's food. Inasmuch as other 
children may become infected, or reinfec- 
tion take place in the one already ill, a 
child with summer diarrhoea should be 
isolated. 

BATHING 

The newly-born child should be given a 
basin bath of lukewarm boiled water and 
Castile soap, until the cord falls off and the 
navel heals. When this has taken place 
the tub bath may be given. In New York 
City the daily bath is thought to be al- 
most as important as fresh air or food. 
Only boiled water should be used. The 
temperature of the bath for the very young 
infant should not be below 95 , nor above 
ioo° F. Very young children should not 
be kept in the water more than three min- 
utes. After the third or fourth month a 
temperature of 90 or 95 ° F. is best, the 
child being kept in the water about ten 



84 Bathing 

minutes. At this age I prefer to have 
the tub bath given at night just before 
the child is put to bed. A basin bath 
may be given in the morning. When 
the child is a year old and fairly vigorous 
the temperature of the water at the be- 
ginning of the bath should be 90^ F., 
which should gradually be reduced to 8o° 
F. by the addition of cold water, the child 
being vigorously rubbed with the hand 
while in the water. The temperature of 
the room should be from 76 to 8o° F. 
during the bath, and windows and doors 
should be closed. When removed from 
the tub the baby should be dried quickly 
and thoroughly, and the folds of the 
skin should be well powdered. A sponge 
should never be used in any portion of 
the bathing process. It should never be 
included in the nursery outfit. It is 
never clean after once being used. Some 
children have a dread of the bath and 
cry frantically when placed in the water. 
This is due to fear and may easily be 
overcome by placing a sheet over the tub 
and lowering the child on it into the water. 



Bathing 85 

Baths are of use for purposes other 
than cleanliness. 

Tub baths for fever. — Place the child in 
water at a temperature of 95 and reduce 
to 75 or 8o° by the addition of ice or cold 
water. The duration of the bath should 
not be more than fifteen minutes, con- 
stant friction being maintained during the 
entire process. 

Basin bathing for fever. — Add eight 
ounces of alcohol to a quart of water at 
a temperature of 70 F. The child is 
stripped and covered with a flannel blanket 
and the entire body sponged with this 
solution for ten or fifteen minutes. 

Either the tub bath or the basin bath 
may be used by the mother in case of 
sudden high fever — 104 to 105 — before 
the physician arrives. The repetition of 
the baths, the use of cold packs and other 
means for the reduction of fever, should 
afterward be left entirely to the physician. 

Bathing for comfort in hot weather. — 
The basin and tub baths may also be used 
by the mother as a means of relief during 
very hot weather. Two or three basin 



86 Bathing 

baths a day in this trying season will give 
the child much relief and help him to pass 
safely through it. The very young feel 
the extreme heat most acutely, and endure 
it with difficulty. I know of nothing that 
will give a restless, uncomfortable, heat- 
tormented child such a refreshing sleep 
as a cool basin bath. 

Mustard bath. — A mustard bath is pre- 
pared by adding a heaping tablespoonful 
of mustard to three gallons of warm water. 
The mustard bath is one of the means of 
treating convulsions ; it will also be found 
useful for children who sleep badly. Two 
or three minutes in the mustard water 
followed by a brisk rubbing immediately 
before going to bed is oftentimes all that 
will be required to induce refreshing sleep. 

Brine bath. — A brine bath — an even 
tablespoonful of salt to one gallon of water 
— is of great service with very delicate, 
poorly nourished children. Its action is 
that of a tonic. If the child is thoroughly 
soaped and washed with plain water and 
then immersed in the brine bath, no 
further tubbing is necessary. The child 



Bathing 87 

should be kept in the bath for ten or 
fifteen minutes, constant friction being 
continued during the entire time. 

Soda bath. — The soda bath is of some 
service in cases of prickly heat, from 
which many children suffer during the 
summer. A tablespoonful of bicarbonate 
of soda should be added to each half gal- 
lon of water used. The temperature of 
the water should be that to which the 
child is accustomed. From two to four 
minutes in the water suffices. There 
should be little or no friction of the 
skin. The child should be dried with soft 
towels. 

Bran bath. — The bran bath is of much 
service in prickly heat. One-half cup of 
bran is mixed with the water in the bath- 
tub and the same method employed as 
for the soda bath. 

Starch bath. — The starch bath is also 
useful in prickly heat. One-half cupful 
of powdered laundry starch is mixed 
with the water in the bath-tub and the 
same method employed as for the soda 
bath. 



88 Earache 

EARACHE 

Infants and young children are very 
susceptible to attacks of earache. They 
usually occur in children who are suffer- 
ing from some inflammatory condition of 
the throat or nose. Such however, is not 
necessarily the case. I have seen ear- 
ache in children who apparently were in 
perfect health. In the very young the 
only symptoms of the trouble may be 
restlessness, fever, which is usually pres- 
ent, and pain, which is manifested by 
crying. I have repeatedly seen an attack 
so severe as to cause an infant to shriek 
with pain. An older child, in addition 
to the above, will raise the hand to the 
side affected or point to the painful ear. 
The child usually is much disturbed if the 
ear is touched or manipulated in any way. 
While severe pain is the rule, it may 
be absent ; there may be loss of appetite, 
high fever and restlessness for three or 
four days with no other sign of illness, and 
no evidence whatever of pain, when sud- 
denly one discovers a yellowish discharge 
from the ear, and all symptoms disappear, 



Earache 89 

In case of an attack of earache, dry 
heat is of much service. Rest the ear 
on a hot-water bag, or apply a salt bag, 
made by sewing together two pieces of 
muslin about three by five inches in size 
and filling it one-half full with salt. The 
bag and contents are then pressed flat, 
heated, and applied to the ear, the salt 
retaining the heat for a long time. An- 
other device is to fill the finger of an old 
glove with salt, heat it, and place the tip 
in the ear. As an extra precaution the 
mother or nurse should first test it in her 
own ear. A douche at no F. may also 
be of considerable service in these cases ; in 
my experience, earache is best relieved by 
this means. The child should be pinned 
in a sheet, and lie on its back, with its 
head on a level with or a little lower than 
the body. A basin protected with a 
towel or absorbent cotton is placed under 
the ear. One assistant is required to 
steady the head, as the child will be sure 
to struggle. The douche bag — an ordi- 
nary fountain syringe, should be held not 
more than two feet above the child's 



90 The Care of the Eyes 

head. From one to two pints of water 
may be needed. The tip of the syringe 
is placed about one-quarter of an inch 
from the orifice of the canal and the 
water is allowed to flow into the ear until 
the child is relieved or until the bag is 
empty. Such a douche may be repeated 
every hour until medical aid arrives. 

Earache is usually due to the presence 
of pus or other fluid behind the drum 
membrane. This causes pressure within 
the ear which may require a slight opera- 
tion for its relief. 

THE CARE OF THE EYES 

The eyes should always be well pro- 
tected from the sunlight, the young infant 
never being allowed to lie with a bright 
light from a window streaming into its 
face. 

The eyes should be washed once daily 
with plain boiled water. A piece of soft 
old linen should be used and immediately 
burned. Before touching the eyes for 
any purpose, the hands must be washed 
with hot water and soap. 



Dentition 91 

No other home treatment of the eyes 
is allowable, however slight the ailment. 
The custom of putting breast-milk into 
the eyes cannot be too strongly con- 
demned. Teas of various kinds and pro- 
prietary or home-made eye-washes should 
never be used. Over 90 per cent, of 
the cases of blindness develop during 
early life, nearly all being due to neglect 
or bad management. 

DENTITION 

Much has been written about the pro- 
cess of teething. Nearly all the ills of 
childhood, other than the contagious dis- 
eases, have been attributed to this cause. 
Not only the laity, but physicians, are 
often inclined to attribute this or that 
ailment to teething. Many a diagnostic 
puzzle has been smothered under the diag- 
nosis of dentition. Observations covering 
the teething period of several thousand 
children in institution, out-patient, and 
private work, among all classes and con- 
ditions of children, have taught me to 
divide teething babies into three groups : 



92 Dentition 

the breast-fed, the well-managed bottle- 
fed, the badly fed. 

The breast-fed. — In the great majority 
of the breast-fed, the teeth appeared at 
the proper time, with little or no disturb- 
ance. Perhaps there was a period of 
irritability and restlessness for a few days 
before the teeth came through. In many, 
the teeth appeared without the slightest 
inconvenience, and that a tooth had been 
cut was discovered while washing or 
dressing the baby. In a very few breast- 
fed babies there were distinct irritability 
and restlessness, with fever and a slight 
diarrhoea, all of which subsided when the 
teeth appeared. 

The well-managed bottle-fed, such as were 
given cows' milk and cream, properly 
prepared and diluted, teethed, as a rule, 
without inconvenience. Some showed a 
tendency to slight gastro-intestinal dis- 
turbance, which was relieved by diet and 
simple medication. The cases which oc- 
casionally developed severe intestinal dis- 
turbances were those which cut the first 
molars or several other teeth at one time 



Dentition 93 

during the hot weather. Such infants 
must be kept on a very light diet until 
the teeth are through, or until the onset 
of colder weather. 

The badly fed. — These were nearly all 
bottle-fed. They were given cows' milk 
improperly prepared or at too frequent 
intervals. Only condensed milk and the 
proprietary foods had been given some of 
these infants. To this class belong the 
great number of infants who are given 
bread, meat, potatoes, and sweets before 
the digestive organs are ready for such 
food. It is these badly fed, debilitated, 
rachitic infants who are said to " teeth 
hard." They teeth late, cut several teeth 
at one time, and have attacks of con- 
vulsions, diarrhoea, and vomiting during 
the teething period. There is no doubt 
that the alimentary tract is predisposed to 
troubles of a catarrhal nature during active 
dentition. If the baby has been properly 
fed and is in fair health, this tendency is 
so slight that it probably will not be 
noticed. If, on the other hand, the di- 
gestive tract is weakened from abuse, 



94 Dentition 

vomiting and diarrhoea often result. The 
majority of children who belong to the 
third group are rachitic, and rickets al- 
ways means enfeebled resisting powers. 
Rachitic children teeth late. A rachitic 
boy under my observation cut his first 
tooth during the ninth month, and with 
the eruption of this tooth and with each 
of the five that appeared at intervals of 
two or three weeks during the next five 
months, an attack of vomiting and di- 
arrhoea occurred, each attack subsiding 
when the tooth pierced the gum. 

Irritability and restlessness, slight fever 
and gastro-intestinal derangements, were 
the only unpleasant effects of dentition in 
any of my patients who were in fair health. 
The irritability, restlessness, and fever ap- 
peared to be due directly to dentition. 
Indirectly, teething may be a factor in 
gastro-intestinal derangements. The pro- 
cess is painful, the digestive organs fail to 
act properly, and trouble follows. I have 
never known dentition to cause bron- 
chitis, eczema or skin eruptions of any 
kind. 



Dentition 95 

The opinion is very general among the 
ignorant, that bronchitis needs no treat- 
ment, and that diarrhoea is beneficial dur- 
ing the teething process. These beliefs, 
equally dangerous, have been the cause of 
an incalculable amount of harm : as the 
result, many lives are lost yearly. I have 
time and again seen children die with 
summer diarrhoea who were brought for 
treatment when no hope could be given. 
The mother had been told and believed 
that diarrhoea was beneficial to the teeth- 
ing child, and that if the diarrhoea were 
stopped the child would be thrown into 
convulsions. 

When the form of a tooth can be made 
out pressing on the gum, and the child is 
fretful and feverish, the digestive capaci- 
ty is lessened, as previously mentioned. 
When such is the case the nourishment 
should be temporarily reduced one-half by 
the addition of boiled water. If the child 
is breast-fed, the nursing period should 
be reduced to. five or six minutes, and 
boiled water given to drink between feed- 
ings. If a tooth is trying to force its way 



96 The Teeth 

through a thick, resistant gum, a great 
deal of pain and discomfort will be spared 
the child if the tooth is assisted in its pro- 
gress. This is best accomplished by the 
use of a clean towel, which is placed over 
the finger and vigorous friction brought to 
bear over the sharp edge of the tooth. It 
is quicker and less painful than lancing, 
and the gum will not close over the tooth. 

THE TEETH 

Twenty teeth comprise the first set. 
In the well child the first tooth usually 
appears between the sixth and the eighth 
months ; the first teeth may, however, 
in perfectly normal cases, come earlier or 
much later. I have known well, vigorous 
children who did not get a tooth until the 
thirteenth month. The first teeth are 
usually the two lower central incisors ; 
generally, the four upper incisors and 
the two lower lateral incisors appear be- 
tween the eighth and the tenth months. 
The first four molars appear between the 
twelfth and the fifteenth months ; the eye- 
and stomach-teeth between the eighteenth 



Care of the Teeth 97 

and the twenty-fourth months ; the four 
posterior molars between the twenty- 
fourth and the thirtieth months. This 
regularity in the appearance of the teeth 
is by no means constant even in well chil- 
dren. I have in several instances seen 
the upper lateral incisors appear first. In 
delayed dentition the teeth are very apt 
to appear irregularly. 

CARE OF THE TEETH. 

As soon as the teeth appear they re- 
quire attention. Until the second year 
is reached the mouth should be washed 
out at least twice a day with a solution 
of boracic acid, — one ounce to a pint of 
water. This can best be done by means 
of absorbent cotton wound around the 
tip of a clean index finger and afterward 
dipped into the solution, when it should 
be applied with gentle friction to the 
gums and teeth. When a child is two 
years old it is well to begin the use of a 
soft tooth-brush, and a simple tooth pow- 
der composed of the following ingredi- 
ents : 
7 



98 The Hair 

Precipitated chalk, i ounce. 
Bicarbonate of soda, i drachm. 
Oil of wintergreen, a few drops. 

The child should also be instructed 
early as to the proper use of a quill tooth- 
pick. 

The milk-teeth are lost between the 
sixth and eighth years. They should not 
decay, but fall out or be forced out by the 
second set. The teeth of every child 
over two years of age should be examined 
by a dentist every six months. If cav- 
ities are discovered in the first teeth they 
should be filled with a soft filling. Chil- 
dren must not be allowed to crack nuts 
with the teeth or bite on any hard sub- 
stance, as the enamel is easily broken 
and decay quickly follows. 

THE HAIR 

Whether the child should wear the 
hair long or short is a point upon which 
the doctor is likely to give unsought ad- 
vice. There are two reasons why a child's 
hair should be kept short. 

i. From the standpoint of comfort. 



Nursery-Maids 99 

During the hot months children perspire 
very freely both by day and by night. 
The heavy mass of hair which falls about 
the neck and shoulders adds greatly to 
the warmth and discomfort. I find that 
many children with long hair are poor 
sleepers and are irritable and hard to 
please when awake. In winter the child 
is very apt to perspire about the head 
and neck in active play, and runs a greater 
risk from exposure than if the excessive 
perspiration did not occur. 

2. The hair should be kept reasonably 
short, because then the scalp can be kept 
in a much healthier condition, and a much 
better growth of hair assured in later life. 

NURSERY-MAIDS 

The mother who can afford the ex- 
pense of a helper should never take en- 
tire charge of her baby ; nor should she 
share this duty with the maid of all work 
if better assistance can be secured. The 
child requires more attention than any 
one person should bestow. If one person 
is constantly in charge of a child it will 

L.ofC. 



ioo Nursery-Maids 

either be neglected or the health of the 
mother or nurse will suffer and conse- 
quently her services be less efficient. 
Many a young mother has sacrificed 
her health because of a false sense of 
duty in this respect. The close con- 
finement in itself would ruin her health 
and make her prematurely old. The 
children . that are born later have less 
vigor, are more susceptible to illness, and 
start out handicapped in life as a conse- 
quence. The constant attention of the 
mother is not necessary : in fact, it is often 
injurious to the child. She is apt to 
handle the child too much, to overenter- 
tain it, to overnurse it. A bright young 
woman should be secured as soon as the 
monthly nurse leaves, to assist in the 
care of the child. If she is a trained 
nursery-maid who has had previous ex- 
perience of the right kind, she will be 
invaluable. In case a trained assistant is 
not to be obtained, any intelligent young 
woman of cleanly habits, and who is fond 
of children, may be trained at home in a 
few weeks. 






The Trained Nurse 101 

THE TRAINED NURSE 

If possible, a trained nurse should be 
employed in every severe illness of child- 
hood. She may alternate with the mother 
or nursery-maid in the care of the child. 
If the case is very urgent, two trained 
nurses should be employed. The nurse 
must never be expected to work for more 
than twelve consecutive hours. A tired 
nurse should never be in charge of a 
sick baby. 

The employment of a trained nurse 
does not mean that the mother may not 
perform many little offices for the patient, 
but the trained nurse should be in charge, 
and her opinions respected. 

Many an excellent mother makes a 
very poor nurse for her own child during 
a severe illness, Her great interest and 
anxiety impairs her judgment. She is 
apt to become confused and fail to meet 
emergencies. A mother who is useless 
for a like office in her own household 
oftentimes makes an excellent nurse for 
her friend's child. The mother in the 
capacity of a nurse for her own infant is 



102 The Trained Nurse 

apt to fail under some of the following 
conditions : She is inclined to put more 
clothing on the baby than the doctor ad- 
vised. If a window is the means of ven- 
tilation, she has a strong inclination to 
close it a little beyond the point which 
the physician marked with a lead-pencil. 
The temperature of the sick-room is often 
kept higher than is good for the baby. 
Offices, the performance of which cause 
the child discomfort, are often not thor- 
oughly attended to, such as washing the 
eyes, sponging off the patient in fever, 
syringing the ears, and adhering to a 
greatly restricted diet. These, and a few 
like offences, are pardonable in the mother, 
but they show us that in a severe illness 
trained help is indispensable. Further, I 
am very sorry to say that sometimes in- 
fluences against carrying out the physi- 
cian's directions in important particulars 
are successfully brought to bear upon 
the mother by well-meaning relatives and 
friends who possess no knowledge what- 
ever of the illness in question. 



Adenoids 103 

ADENOIDS 

Adenoids are tumor-like growths that 
develop at the junction of the upper por- 
tion of the posterior pharyngeal wall and 
the vault of the pharynx. They may 
simply cover the surface of the parts in a 
spongy layer or they may fill the entire 
naso-pharyngeal space, completely block- 
ing the passage from the nose to the 
throat. They are not to be considered as 
new growths but rather as hypertrophies, 
or overgrowths, of the mucous glands and 
tissues of the parts. They may vary in 
size from a flaxseed to a walnut. Among 
the causes of adenoids may be mentioned 
the use of the "pacifier" in infancy, re- 
peated " colds " in the head, breathing 
the dust-laden air of our large cities, mal- 
nutrition, and unhygienic living. While 
the taking of cold is a factor in the devel- 
opment of adenoids, my observation is 
that predisposition plays an important 
part. Many children have a tendency to 
glandular enlargement ; in fact, in New 
York City, a large percentage of the 
children under ten years of age have 



104 Adenoids 

adenoids. In a child under two years of 
age the naso-pharyngeal space is a very 
narrow slit ; and since the majority of 
children up to the eighteenth month of 
life are sucking on something the greater 
part of their waking hours, the soft pal- 
ate is forced back against the posterior 
pharyngeal wall, interfering with the drain- 
age of the parts, and on account of the 
friction of the opposed surfaces conges- 
tion and irritation follow, resulting finally 
in a general hypertrophy. 

Very young children may have ade- 
noids. The youngest patient that I have 
operated upon was eight months old. 
The majority of cases occur in children 
from eighteen months to six years of age. 
A slight amount of adenoid growth may 
cause no symptoms. A few summers 
ago I examined the throats of forty chil- 
dren between the ages of two and five 
years, who came for treatment for other 
conditions. In thirty-seven adenoids were 
present. In twelve operation was advised, 
and in five operation was performed. In 
fifteen the growths were not sufficiently 



Adenoids 105 

large to justify operation in the absence 
of annoying or dangerous symptoms. 

The presence of adenoids is perhaps 
most often manifested by symptoms of 
chronic cold in the head. There is a great 
deal of discharge from the nose. The 
child has snuffles all winter. During sum- 
mer there is little if any trouble. The 
child is said to take cold easily. The 
slightest exposure will cause a running at 
the nose. Cough is often associated with 
the nasal discharge, or it may follow it. 
The cough is worse at night; in fact, it 
often is not noticed until the child goes to 
bed. Such a cough was formerly known 
as '• the nervous cough " or " the stomach 
cough." 

If the growths are large, we have mouth- 
breathing added to the other symptoms. 
The child breathes through the mouth 
both day and night for the reason that 
the breathing space through the nose is 
choked. The night mouth-breathing 
gives rise to snoring ; some of these 
children snore like adults. Almost 
every snoring child will be found to 



106 Adenoids 

have either adenoids or enlarged tonsils, 
or both. 

In advanced cases the appearance of 
the face of the patient is characteristic. 
The habitual open mouth gives the face a 
stupid expression. In fact, such children 
are apt to be dull. The nostrils are small 
and pinched. The upper lip is usually 
thickened. The voice is also affected, 
there is a decided nasal twang, and artic- 
ulation is sometimes impaired. The child 
has trouble in blowing his nose. Occa- 
sionally adenoids are the cause of very 
severe nose-bleed. In a small proportion 
of the cases the hearing is impaired. Bed- 
wetting may be due to adenoids. Re- 
cently a writer reported seven cases of 
inveterate bed-wetters, all cured by the 
removal of the adenoids. These children 
are more susceptible to diphtheria, and if 
they contract the disease it is apt to be 
more severe. For adenoids of any degree 
of severity, complete removal is the only 
treatment. Sprays and the various local 
applications are absolutely worthless. The 
operation is practically without danger. 



Enlarged Tonsils 107 

ENLARGED TONSILS 

Chronic enlargement of the tonsils is 
almost always associated with adenoids 
and is responsible in a degree for their 
presence. We see many cases of ade- 
noids, however, in which there is no 
tonsillar enlargement. Predisposition and 
repeated attacks of acute tonsillitis lead 
to chronic enlargement of the tonsils. 
Enlarged tonsils, when associated with 
adenoids, do not change the character of 
the symptoms of adenoids except to 
aggravate them ; therefore they should 
be removed as well as the adenoids. All 
other treatment in young* children is use- 
less. The operation in skilful hands may 
be said to be practically without danger. 
Parents always dread the operation, but 
the relief afforded the suffering child, 
and the knowledge that a serious obstacle 
to the child's growth and development has 
been removed, will repay them for their 
hours of anxiety. Gargles and sprays are 
of little or no value in chronic enlarge- 
ment of the tonsils. 



108 Milk in Infants' Breasts 

MILK IN INFANTS' BREASTS 

It is not at all uncommon for an infant's 
breasts, at birth, to contain a substance 
resembling milk. When this occurs, the 
breasts are to be left alone and the milk 
will disappear, It is quite a common be- 
lief among hospital and dispensary pa- 
tients that the milk should be pressed out. 
This is very wrong. In two cases I have 
known abscesses to develop after this 
treatment by a midwife, and in one case 
the child nearly lost its life. 

TEMPERATURE, AND HOW TO TAKE IT 

The normal rectal temperature of an 
infant varies between 98. 5 and 99 . The 
temperature should be taken in the rec- 
tum. The mouth is impossible, the groin 
and axilla absolutely unreliable. The 
child should lie on its stomach either in 
its bed or across the nurse's lap. Both 
the anus and the bulb of the thermometer 
should be well oiled. The bulb is passed 
into the rectum so that the mercury can- 
not be seen and allowed to remain three 



Appetite 109 

minutes. If the child kicks or struggles 
some one should hold his legs. The 
thermometer should be washed with a 
one-per-cent. solution of carbolic acid 
after using. 

APPETITE 

It may be safely said that a well, vigor- 
ous child is a hungry child, and nearly 
every child may be made thoroughly hun- 
gry three times a day by suitable food at 
proper intervals. The children who come 
under my care for poor appetite, without 
evidence of disease to account for it, are, 
almost without exception, improperly fed. 
They are often given unsuitable food at 
meal-time, when they are loaded down 
with sweets and pastries ; but the chief 
error is eating between meals. This 
habit has ruined more appetites and has 
been the cause of more stomach disorders 
than any other one factor. It is sur- 
prising what a large amount of candy, 
sweet crackers, and the like are disposed 
of in many households. Every year I 
am called upon to treat cases of loss of 



1 10 Appetite 

appetite in ''run-abouts" from eighteen 
months to three years of age, who have 
what I have designated the milk habit. 
These children drink from five to six 
pints of milk a day, and refuse all other 
food. The milk satisfies the appetite but 
does not furnish the nourishment required 
for the rapid growth that takes place at 
this time, and the child in consequence 
suffers from malnutrition. He is pale, 
thin, and sallow in appearance, the sleep is 
poor, and the child is irritable and hard 
to please. We also see children at this 
age who suffer from improper nutrition 
on account of too restricted a diet. They 
take other food than milk, but not in 
sufficient quantity or variety. Some will 
refuse all kinds of vegetables, others will 
refuse all kinds but one or two ; some 
will not take stewed fruit ; others will not 
touch meat or eggs, no matter how they 
may be prepared ; some will take but one 
cereal, others will refuse cereals alto- 
gether. The child's whims in these re- 
spects must never be catered to. He is 
to take what is placed before him or go 



Appetite 1 1 1 

without until the next meal. Likes and 
dislikes for various articles of diet are 
largely a matter of education, and the 
child may, and should, be taught to eat 
everything that is good for him. A little 
firmness in compelling him to go hungry 
for a few hours will soon do away with 
any childish fancy, which may be the 
cause of considerable harm. These chil- 
dren are rapidly growing, and for proper 
growth and development require a mixed 
diet. If the child is wedded to milk and 
refuses everything else, the milk must 
temporarily be discontinued. Some chil- 
dren with a poor appetite for solids will 
drink a glass or two of milk at the com- 
mencement of a meal. This satisfies the 
appetite for the time and nothing more 
will be taken. With such children the 
milk must be kept out of sight until the 
meal is completed, when one-half pint 
may be given. 

I have treated quite a number of cases 
of poor appetite and milk appetite in 
children otherwise well, in the follow- 
ing manner : The child is undressed and 



lis Appetite 

placed in bed and put under the care of 
one person as though he were very ill. 
The object in placing the patient in bed 
is to prevent his getting food other than 
that ordered. He is allowed water to 
drink in plenty. For the first day he is 
given four ounces of plain chicken or 
mutton broth every three hours. The 
second day he receives six to eight ounces 
of the broth at three-hour intervals. On 
the third he is usually ravenously hungry 
and he is then given three or four good 
meals, when, if he has any special dislike 
for any article of diet, that is included 
in the first meal. In such cases it is sur- 
prising with what favor the formerly de- 
spised cereal, meat, Qgg y or vegetable, 
will be looked upon, and it will there- 
after have a cherished place in the child's 
heart. Some mothers will not be a 
party to such heartless treatment, as they 
are inclined to call it, but this is a wrong 
view to take of it. A complete change 
of diet for a day or two would often 
be of benefit to all of us. With the 
child the advantage derived from thus 



Habits 113 

learning to enjoy a mixed diet will favor- 
ably influence his health for the rest of 
his life. Change of climate, fresh air, 
out-of-door exercise, suitable food at reg- 
ular intervals — all favorably affect the 
appetite. 

HABITS 

the pacifier; ear-pulling, and masturbation 

Babies acquire habits most easily and 
at a very early age. Whether the habits 
are good or bad depends more upon the 
child's attendants than upon the child 
itself. If properly trained — and the train- 
ing must begin at birth — a baby will 
acquire the habit of taking his food at 
regular intervals by day and by night, 
and he will also acquire the habit of going 
to sleep and waking at regular intervals. 
As a result of a careful regime re^ardino* 
feeding, sleep, bathing and airing, and 
the performance of its various functions 
at stated times every day, the baby will 
soon develop into a 4i little machine," 
as one mother called her babe. Such 
a child causes no trouble and thrives far 



ii4 Habits 

better than one who is fed every time 
he cries, day or night. A baby that re- 
quires constant entertaining when awake, 
and that sleeps only when exhausted, 
usually has another bad habit, — that of 
being held constantly in arms. A baby 
should be handled very little, — just 
enough to give it exercise. It will learn 
to amuse itself at a very early age if given 
an opportunity. 

The "pacifier" habit, — the habit of 
sucking a rubber nipple, is an inexcusable 
piece of folly for which the mother or 
nurse is directly responsible. The habit 
when formed is most difficult to give 
up. The use of the " pacifier/' thumb- 
sucking, finger-sucking, etc., make thick, 
boggy lips, on account of the exercise to 
which the parts are subjected. They cause 
an outward bulging of the teeth and a 
narrowing of the jaws, which are not 
conducive to personal attractiveness. 
Nature has not been so lavish of her gifts 
to the great majority of mankind that 
they can afford to trifle with her handi- 
work. Furthermore, the " pacifier" is 



Habits 115 

often a menance to health. If there are 
two or three young children in the family 
it is frequently passed around without 
other means of cleansing than being drawn 
a couple of times across the nurse's sleeve. 
This novel method of disinfecting the 
" pacifier " may be seen in actual use in 
the Park any pleasant day, and I have 
often seen the mother or nurse moisten 
the " pacifier " with her own lips before giv- 
ing it to the child. I have seen young 
children fight for the "pacifier," one tak- 
ing it from the mouth of another ! It may 
readily be conceived what a boundless 
source of harm this little instrument may 
be, when every sort of disease known to 
childhood may be transferred by it. Thus 
it may act as a means of transmitting 
tuberculosis, syphilis, diphtheria, and many 
other ailments of minor importance. 

Adenoids, referred to in another chap- 
ter, are often the result of thumb-sucking 
or the use of a " pacifier." The pressure 
exerted in sucking forces the uvula against 
the posterior pharyngeal wall ; this irritates 
and stimulates the glands of the part, 



n6 Habits 

which in time enlarge, and adenoids 
develop. 

To break the child of the "pacifier" 
habit, burn the "pacifier" and do not buy 
another, as is sometimes done. For thumb- 
sucking and finger-sucking, bandage the 
hands and moisten the bandage occasion- 
ally with a solution of quinine. 

A few children develop the ear-pulling 
habit. It is always one ear and usually a 
certain portion of the ear which receives 
attention. Sometimes it is the lobe and 
sometimes the upper portion. The child 
pulls on the ear the greater portion of 
its waking hours. As a result of this 
practice, I have seen ears drawn entirely 
out of shape. Bandaging the hands so that 
the fingers cannot be used to grasp the ear 
is the best means of breaking the habit. 

Occasionally children are met with who 
have a mania for placing foreign bodies in 
the nose and ear. Shoe buttons are the 
favorites, although beans, pieces of coal, 
pebbles, and various other kinds of but- 
tons serve the purpose when shoe buttons 
are scarce. The habit is best controlled 



Habits 1 1 7 

by a vigorous spanking following each 
offence. 

Masturbation is one of the most injuri- 
ous of habits. It consists in an irritation 
of the genitals by manipulation, by leg- 
rubbing, or by pressing the parts against 
some pointed object. Under the age of 
six years masturbation is more common 
in girls than in boys. My youngest 
patient was a girl only six months old. 
If the habit is not detected, masturbation 
may be practised for a long time and 
repeated many times a day.. As a result 
the child becomes irritable, loses sleep 
and weight, and is transformed into a con- 
dition of mental and physical exhaustion. 

The formation of habits and their cor- 
rection rests largely with the mother or 
attendant. Considerable stability is neces- 
sary for the correction of a bad habit, 
or the formation of a good one. It means 
several prolonged crying attacks on the 
part of the child and perhaps two or three 
wakeful nights. To cure the habit of 
masturbation, if the child is under eighteen 
months of age, the hands may be ban- 



n8 The Normal Throat 

daged, or, what is better, a piece of tape 
may be fastened around each wrist and 
tied together at the back of the neck, 
making all secure with a safety-pin. The 
pieces of tape should be of sufficient length 
to allow the child free movement of the 
hands, but not long enough to allow them 
to come in contact with the genitals. 

Leg-rubbing is more frequently seen 
in very young girl babies. In such cases 
the wearing of a thick napkin or of two 
napkins will usually prevent the practice. 
In children over two years of age, con- 
stant watchfulness and vigorous punish- 
ment for each offence, combined with 
medical treatment, will cure most cases, 
although with some much difficulty will 
be experienced. 

THE NORMAL THROAT 

Every mother should learn the appear- 
ance of the healthy throat, and every 
child should be accustomed to throat 
examination. It will soon learn that no 
harm is intended and force will not be 
required. The family physician should 



How to Examine the Throat 119 

demonstrate to the mother the color of 
the normal mucous membrane, and the 
size and appearance of the tonsils in 
health. By knowing the normal throat 
she will be able to recognize inflamma- 
tion, swelling, and exudation in the form 
of the cheesy dots seen in tonsillitis, and 
the membrane in diphtheria. With the 
first appearance of exudation of any kind, 
medical aid should be summoned. No 
chances should be taken with these cases. 
I know of fathers and mothers who will 
never cease to regret that they did not 
appreciate the dangers of temporizing 
with what they considered a "cankerous 
sore throat." Diphtheria is most insidious 
in its onset and a sore throat should never 
be neglected. 

HOW TO EXAMINE THE THROAT 

(See Fig. 8.) 

In order to examine a baby's throat 
quickly and thoroughly the child must be 
held in front of and at the right side of 
the attendant, supported by the attend- 
ant's left arm under the buttocks ; the 




FIG. 8. THE THROAT EXAMINATION. 



1 20 



Thrush 121 

right arm, which is thus left free, is passed 
around the child, binding its arms to its 
sides. The child's head rests upon the 
right shoulder of the attendant. 

The mother places her left hand on the 
child's head to steady it and with tongue 
depressor or teaspoon in her right hand 
she presses down the tongue, and, with 
the child under perfect control, she brings 
into view the parts that are to be exam- 
ined. The most satisfactory view can be 
obtained by daylight before a window. 
If the examination is made in the even- 
ing, a lamp or taper held by a third party, 
a trifle above and behind the mother's 
right shoulder, will furnish a satisfactory 
illumination. 

THRUSH 

Thrush, also known as Sprue, is a dis- 
ease of the mouth, seen most frequently 
in delicate and neglected bottle-fed in- 
fants. The mucous membrane covering 
the tongue and the inner side of the 
cheeks is chiefly involved. In mild cases 
there will be visible a few patches of a 



122 Thrush 

yellowish-white fungoid growth. I n others, 
the entire mucous membrane will be thickly 
covered by a growth which somewhat re- 
sembles finely curdled milk. Considerable 
force is necessary to remove it. The parts 
not affected by the growth will be found 
reddened and congested. The disease is 
attended with considerable pain and dis- 
comfort. There may be slight fever, but 
the principal symptom will relate to the 
taking of food. The child will be eager for 
the bottle, and when it is given him he 
draws for a few times, pushes the nipple 
from his mouth, and cries ; sometimes the 
bottle will be refused altogether, necessi- 
tating feeding with a spoon. Whatever 
form of artificial nourishment is given, it 
will usually be taken better if given cool. 

Thrush can usually be traced to one 
cause — lack of cleanliness, either of the 
mouth or the bottle and nipple, or to the 
use of the "pacifier." 

The treatment consists in removing 
the cause and in gently washing the 
mouth after each feeding with a satu- 
rated solution of boracic acid. This can 



Stomatitis, or Sore Mouth 123 

best be clone by wrapping around the 
index finger a piece of absorbent cotton 
which is saturated with the solution and 
then gently bringing it in contact with 
the inflamed parts. If a little of the so- 
lution is swallowed no harm results. 

The washing should be repeated after 
each feeding. 

STOMATITIS, OR SORE MOUTH 

There are three varieties of this dis- 
order : — the catarrhal^ the aphthous, and 

the ulcerative. 

In the catarrhal form there is redness 
of the gums with excessive secretion of 
saliva. 

In aphthous stomatitis, distinct gray- 
ish-white plaques will be noticed on 
the inner side of the cheek and under- 
surface of the tongue, varying in size 
from a pin-head to a split pea. 

Ulcerative stomatitis is the most serious 
disease of the three. It may occur dur- 
ing serious illness, but in most instances 
it occurs independently. There is a gen- 
eral congestion of the mucous membrane 



124 Stomatitis, or Sore Mouth 

with the secretion of a great deal of 
saliva. Its distinguishing point, however, 
is the line of ulceration which forms on 
the border of the gum at its junction 
with the teeth. The ulceration may be 
so severe as to cause a loosening and 
falling out of the teeth. The breath is 
often very foul, and the gums bleed at 
the slightest touch. 

Lack of cleanliness plays a large part 
in causing sore mouth. Unclean feeding 
apparatus, the use of the " pacifier," and 
the custom of allowing a baby to put 
into its mouth everything within reach 
account for a majority of the cases. 

The symptoms are fever, loss of appe- 
tite, and evidences of much discomfort 
when the child attempts to eat. In many 
cases of the ulcerative form there are high 
fever and greater prostration than one 
would think possible. 

The prevention and treatment are the 
same — cleanliness. The sore mouth 
should be washed with a saturated solution 
of boracic acid after each feeding, using 
absorbent cotton, which is wrapped around 



Taking Cold 125 



o 



the index finger. The cotton is saturated 
with the solution and gently brought into 
contact with the diseased surface. Force 
must not be used in these cases, as more 
damage than benefit will result if the 
tissues are lacerated. In the ulcerative 
form internal treatment is required in 
addition to the local means suggested. 
Every case of ulcerative stomatitis should 
be seen, at least once, by a physician. 

TAKING COLD 

By "taking cold" we understand that 
through the influence of cold upon some 
portion of the skin an impression similar in 
nature to that of shock is produced, which 
affects the entire body and manifests 
itself most frequently in the form of a 
congestion of the mucous membrane of 
the respiratory tract, between which and 
the skin there seems to be an intimate 
connection. Micro-organisms play an 
unknown though probably important role 
in the process. They are found in large 
numbers on the diseased mucous surfaces. 
The changes in the mucous membrane 



i26 Taking Cold 

resulting from the exposure prepare the 
parts for their growth and development. 
The taking of cold means previous ex- 
posure, and what will constitute a suffi- 
cient degree of exposure in one individual 
may produce no effect in another. Ac- 
cording to my observation the most 
frequent cause of colds in infancy is the 
action of cold air on a moist skin. The 
child that perspires readily, or the child 
that is made to perspire by unsuitable 
clothing, suffers most in this respect dur- 
ing the cold season. I look upon inade- 
quate head-covering as a most frequent 
cause of diseases of the respiratory tract 
in the young. Most infants are dressed 
for the daily outing in a warm room 
with the temperature ranging from 75 ° 
to 85 . The child is wrapped in ample 
coats, blankets, and leggings ; he is active, 
throws his legs and arms about ; the dress- 
ing thus far requires quite a period of time ; 
he perspires freely, but the dressing is not 
completed. On the head is placed one 
of the more or less artistically decorated 
airy creations which are sold in the shops 



Taking Cold 127 

as children's caps. They furnish little 
protection for the many square inches of 
the almost bald little head. The child is 
taken out of doors ; a wind is blowing ; 
the result is a cold, and how it came 
about is never understood. He was 
supposed to be dressed ideally for cold 
weather. The idea is common and to a 
certain degree proper that a child's head 
should be kept cool. This theory, how- 
ever, gives rise to carelessness as to the 
head-dress. During the colder months I 
advise mothers to make a skull-cap out of 
thin flannel, which the child wears under 
the regular outing cap. 

Allowing a child to sit on the floor dur- 
ing the winter months is probably the 
next most frequent cause of taking cold. 
Kicking off the bedclothes at night is 
another frequent cause. Taking the 
child from a warm room through a cold 
hall is not without danger. Holding the 
child for a few moments by an open win- 
dow during the cold weather is often fol- 
lowed by croup, bronchitis, and pneumonia. 
The uneven temperature of the living- and 



i28 Taking" Cold 



& 



sleeping-rooms in many of our New York 
apartments is a very frequent cause of cold. 
Frequently during the day the tempera- 
ture will be between 75 and 8o°, but at 
night, when the fires are banked, it falls 
to 55 or 6o° or lower. The child went 
to bed warm and perspiring, kicked off 
the bedclothes ; the temperature in the 
room fell, the body became chilled, and 
the child took cold. 

Among rachitic children there is a 
marked predisposition to catarrhal affec- 
tions ; they acquire laryngitis and bron- 
chitis upon very slight provocation. 

In many instances colds in infants are 
attributed to the bath. Among dispen- 
sary mothers this is often considered a 
cause of cold. I have never known a 
cold to be due to a bath. 

Adults and " runabout " children with 
coughs and colds should not come in con- 
tact with infants. There is undoubtedly 
an element of contagion in such cases. 
It is a very bad practice to have a family 
pocket-handkerchief. The youngest in- 
fant is entitled to a handkerchief inde- 



Taking Cold 129 

pendent of the other children, and a hand- 
kerchief should never do service for more 
than one individual between washings. 

Mothers can do little without medical 
aid in the treatment of colds but they 
can do much in preventing them. The 
temperature of the living-room should 
range from yo° and 72 , the sleeping- 
room from 66° to 68°. Of course it will 
be impossible to keep the temperature at 
all times at these figures, but the closer it 
approximates to them the safer the child 
will be. 

Children must not be allowed to sit on 
the floor during the winter. They can 
have their playthings on the bed, on the 
sofa, or in a clothes-basket which may be 
raised on two thick pieces of wood or a 
couple of books. There is always a 
draught near the floor. The "pen" re- 
ferred to on page 254, is the best scheme 
that I know of for keeping children from 
the floor. 

The room in which the child is dressed 
for an outing should not be above 70 
F. Securely pinning bed-blankets to the 



13° Cough 

mattress, or, better, a combination suit 
with " feet," will do much to prevent the 
child from taking cold at night. 

COUGH 

In an infant or young child a cough 
which is not due to whooping-cough may 
almost, without exception, be accounted 
for by some abnormal condition of some 
portion of the respiratory tract. It may 
be due to a diseased state of the mucous 
membrane of the nose, throat, or bronchial 
tubes, or to disease of the lungs or pleura. 
The most common cause of cough is an 
inflammation of the tracheal and bronchial 
mucous membranes. Adenoids, also, are 
a common cause of cough. They are a 
most common cause of the troublesome 
night cough which disturbs the child as 
soon as he lies down and which, in many 
cases, continues a greater part of the 
night. I have yet to see a cough due to 
dentition or worms ; neither has it been 
my lot to have the so-called " stomach 
cough " demonstrated to my satisfaction. 

The above types of cough, together with 



Tonsillitis 131 

the so-called " nervous cough," — another 
creation of the imagination, — have all 
been due, according to my observation, 
to chronically diseased tonsils or adenoids, 
or both combined. All of these varieties 
of cough may be cured in a few seconds 
by the proper operative treatment of the 
diseased parts. In many cases it is puz- 
zling to differentiate between the severe 
night cough produced by adenoids and 
the early stage of whooping-cough. 

TONSILLITIS 

Tonsillitis, or inflammation of the ton- 
sils, is a very common ailment among 
children during the colder months. It 
usually follows exposure. The onset is 
generally sudden, with high fever, — 103 
to 105 F., — pain, swelling, headache, and 
general muscular soreness. Inspection of 
the throat will show the tonsils to be 
swollen and inflamed. The entire throat 
generally has a congested appearance. 
No other changes may be noticed. In 
the majority of cases, however, the tonsils 
will be found studded with small white 



i3 2 Cold in the Head 

dots of a cheesy material. If the case is 
seen two or three days after the begin- 
ning of the illness the dots may have 
coalesced, forming large yellowish patches 
which so closely resemble the appearance 
of the throat in diphtheria, that it may be 
impossible for the physician without the 
aid of a microscope to differentiate be- 
tween the two diseases. An attack of 
tonsillitis runs its course in from two to 
five days. Cold applications, cold com- 
presses to the throat, and cold spongings 
of the body afford the patient much 
relief. A dose of castor oil given at the 
first symptom of the disorder will always 
be of value. 

COLD IN THE HEAD 

A cold in the head is a very frequent 
occurrence in the young, and while not 
serious if the trouble limits itself to the 
mucous membrane of the nose, it is, 
nevertheless, a source of much annoyance 
to both mother and child. The mucous 
membrane of the nasal passages is con- 
gested and swollen. The nostrils of 



Bronchitis 133 

infants in health are very narrow, so that 
a slight congestion will greatly interfere 
with the breathing. 

The first sign to be noticed is that 
when the child is nursing he is unable to 
breathe easily through the nose, and 
frequent rests are necessary. Sleep, for 
this reason, is also interfered with. The 
baby sneezes more than usual and there 
is a watery discharge from the nose with 
usually a degree or two of fever. With 
the onset of the first symptoms, one 
teaspoonful of castor oil will be of service. 
A few drops of melted vaseline may be 
dropped into the nostrils every two hours. 

The danger from a so-called " cold in the 
head " rests in the fact that the inflamma- 
tion does not always limit itself to these 
parts. It is very liable to extend to other 
portions of the respiratory tract, terminat- 
ing sometimes, even if properly treated, in 
bronchitis or broncho-pneumonia. 

BRONCHITIS 

Bronchitis may occur as a primary ill- 
ness, or it may follow a cold in the head, 



134 Bronchitis 

laryngitis, or any inflammatory condition 
of the respiratory tract. It often occurs 
as a complication of other diseases. 
There is almost alwavs more or less 
bronchitis with measles. In bronchitis 
we have a serious illness ; not necessarily 
serious in itself but mainly so because of 
the frequency with which it leads to 
catarrhal pneumonia. Bronchitis in a 
delicate child requires but a little bad 
management or neglect and pneumonia 
will surely develop. 

The reason why bronchitis is a danger- 
ous illness in a young child is because of 
the lack of development of the parts 
which form the chest walls. The ribs 
are soft and the muscles weak. The 
bronchial tubes collapse readily. In an 
older child the bronchial secretions are 
coughed into the mouth and swallowed 
or expectorated. The young infant can- 
not expectorate. When the secretion is 
viscid and thick the weak chest-wall fails 
to furnish the power required to expel it 
and instead it is drawn deeper into the 
lungs, the smaller tubes become clogged 



Bronchitis 135 

with mucus, the air vesicles collapse, bac- 
teria multiply rapidly in the confined se- 
cretions, and pneumonia results. 

Bronchitis is indicated by coughing and 
wheezing, and what the mother often calls 
" a drawing of the chest." In most cases 
fever is present in a marked degree. The 
severity of the cough and the other symp- 
toms depend entirely upon the severity of 
the lesions. In many cases, if seen early 
the disease will respond to treatment in a 
day or two. A generous counter-irritation 
of the chest with one part of turpentine 
and three parts of camphorated oil is a 
useful measure, the applications to be 
made twice a day, — morning and evening. 
What is better, however, is the use of 
the mustard plaster, made by mixing one 
part of mustard with three parts of flour, 
sufficient warm water being added to 
make a paste which may be spread on 
cheesecloth or thin muslin. It should 
be large enough to encircle the chest, 
fitting the child like a jersey. This is 
covered with another piece of similar 
material and the plaster is complete. It 



13 6 Croup 

should be wrapped around the chest 
and allowed to remain from ten to fifteen 
minutes — until the skin is thoroughly 
reddened. 

Proprietary cough mixtures and home 
remedies should never be relied upon for 
the treatment of bronchitis in children. 

CROUP 

CATARRHAL CROUP ; DIPHTHERITIC CROUP 

There are two varieties of croup, catar- 
rhal and diphtheritic ; catarrhal croup a 
catarrhal inflammation of the larynx, and 
diphtheritic croup a membranous inflam- 
mation of the larynx. 

Catarrhal croup may begin in two ways. 
The child will suffer from snufifles, indicat- 
ing a simple cold in the head, which is fol- 
lowed by a slight fever and a mild cough. 
The cough rapidly becomes worse and is 
hoarse and barking in character, becoming 
more severe toward evening. As a rule, 
the fever is not high. In the evening of 
the second or third day of the illness, some- 
times the first day, signs of obstruction 



Croup 137 

to the breathing become apparent. The 
inspiration is labored and accompanied 
by a croaking sound. The child cannot 
speak above a whisper. 

Probably not over half of the cases 
show this gradual development. In many 
the onset is sudden ; the child goes to 
bed as well as usual ; after a quiet sleep 
of a few hours he awakes suddenly, sits 
up in bed, and with high-pitched cough, 
straining for breath, he startles the house- 
hold. 

Membranous or diphtheritic croup is 
much the more dangerous affection, but to 
the mother there is no means of distin- 
guishing between the two forms, unless 
the child has diphtheria and the croup 
follows. The two forms may appear in 
identically the same way, although the 
onset of the diphtheritic croup is usually 
more gradual. 

In case of a severe cough or a sharp 
attack of croup in one of the children, 
the mother or nurse in charge has three 
duties to perform : send for the doctor, iso- 
late the child, and give him a teaspoonful 



i3 8 Pneumonia 

of the syrup of ipecac, which may be 
repeated in fifteen minutes if there is no 
vomiting. Every case of croup should 
be quarantined until the nature of the 
trouble is determined. If it is catarrhal, 
no harm will be done by the isolation. If 
it is diphtheritic, the lives of other mem- 
bers of the household may be saved by 
the precaution. If a croup-kettle is at 
hand, it should be brought into use after 
making a tent by covering or draping the 
crib with a sheet. A cold compress ap- 
plied to the throat is often beneficial also. 
It should be thoroughly wrung out, covered 
with some dry material, and changed every 
twenty minutes. The child should receive 
a laxative as early as possible in the attack. 

PNEUMONIA 

Pneumonia, sometimes referred to as 
inflammation of the lungs, or lung fever, 
occurs very frequently in infants and 
young children. It may appear as an in- 
dependent affection or as a complication 
of other diseases. There are two varie- 
ties which are commonly met with in the 



Pneumonia 139 

young : lobar pneumonia, which corre- 
sponds closely to the adult type, and 
broncho-pneumonia, or, as it is sometimes 
called, catarrhal pneumonia. 

Lobar pneumonia usually results from 
exposure — a sudden chill of some part of 
the surface of the body. 

Broncho-pneumonia is usually the out- 
come of what is known as " a common 
cold." 

The latter is most frequently seen in 
children and is usually the variety which 
occurs as a complication of other diseases. 
The mode of onset of the two types va- 
ries. With lobar pneumonia the onset is 
sudden ; there may be a chill or a convul- 
sion. Sometimes vomiting ushers in an 
attack. The fever rises rapidly to 103° or 
105 F. The face is flushed and wears 
an anxious expression ; the breathing is 
rapid, the respirations being from 40 to 60 a 
minute, the expiration being accompanied 
by a peculiar, partially suppressed sigh. 
The child is very restless, often delirious, 
or there may be stupor, with symptoms 
pointing to a complicating meningitis. 



i4° Pneumonia 

All the symptoms disappear with the 
advent of the crisis, when the fever sud- 
denly abates and fails to rise again. The 
crisis may be expected any time between 
the third and eleventh day of the recov- 
ery cases. In the majority of my cases it 
has occurred from the fifth to the seventh 
day, in a few not until the ninth day, and 
in two it did not occur until the eleventh 
day. 

The prognosis of lobar pneumonia 
in children is good. A very small per- 
centage fail to recover. A patient of 
mine, a three-year-old boy, passed through 
two distinct attacks in a single winter, the 
second after an interval of ten weeks. 

In catarrhal or broncho-pneumonia the 
story is different. There may be a pneu- 
monia at the commencement of the illness, 
but according to my observation, which 
covers several hundred cases, the majority 
begin with symptoms of a common cold 
or bronchitis, the lungs becoming involved 
gradually. In other words, the onset is 
gradual, not sudden, whether it occurs in- 
dependently or as a complication of some 



Pneumonia 141 

other disease. There are cough, often 
distressing, moderate fever, rapid breath- 
ing, and, later, emaciation. Broncho- 
pneumonia in children is an affection of 
extreme gravity. There is no well- 
defined crisis as in lobar pneumonia. 
The disease may last a week or two 
weeks, or it may continue for months. 
In one of my cases, — a child eighteen 
months of age, the disease continued 
three months before the low fever abated 
and the lungs were clear. The recovery 
cases usually require from three to four 
weeks before the lungs may be considered 
normal. 

The sick-room of a patient ill with 
pneumonia should be large, with one win- 
dow open at least four inches from the 
top. The temperature of the room 
should not be below 68° or above jo° F. 
The child should be put on a reduced diet 
of animal broths, thin gruels, and diluted 
milk. 

Prevention resolves itself into proper 
care of the child, proper clothing, avoid- 
ance of unnecessary exposure, and an 



H 2 The Contagious Diseases 

appreciation of the fact that with a child it 
is almost as necessary to call a physician 
for a common cold or bronchitis as it is 
for scarlet fever or diphtheria. 

THE CONTAGIOUS DISEASES 

A contagious disease is one due to a 
specific poison which under favoring con- 
ditions possesses the power of reprodu- 
cing itself in the person of another. The 
poison of the disease, the contagium, may 
be transmitted either directly by contact 
with an individual suffering from the dis- 
ease or indirectly by means of some per- 
son or object, such as the clothing or 
hands of the attendants, which have been 
in contact with the one infected. Accord- 
ing to my observation, personal contact 
with the infected is required in a large 
proportion of cases. Measles and whoop- 
ing-cough are unquestionably the most 
contagious diseases of this type, requiring 
for their transmission only a very slight 
exposure. German measles and chicken- 
pox are next in order of communicability ; 
while scarlet fever is less contagious than 



The Contagious Diseases 143 



*£> 



any of those mentioned — a close contact 
and a fairly long exposure being usually 
required. Clothing may be infected by 
the contagium of scarlet fever and diph- 
theria, the poison remaining inactive for a 
long time. 

A little girl, four years of age, who 
lived in one of the Hudson Valley vil- 
lages, contracted scarlet fever while on a 
visit to a neighboring town ; the case was 
a severe one and the child died. A coat 
which she had worn when stricken with 
the disease was considered too valuable to 
be destroyed and was carefully laid away 
in a bureau drawer. Twelve months later 
the mother decided to give the coat 
to a neighbors child. It was removed 
from the bureau, which had remained un- 
opened, and placed on the little one. In 
five days she was attacked with scarlet 
fever. These were the only two cases 
that had occurred in the village. The 
second child had not been away from 
home and the jacket was the only possi- 
ble means of infection. 

Diphtheria through personal contact 



144 Scarlet Fever 

alone is probably the least contagious of 
any of the diseases belonging in this 
group. Its virulence, however, renders 
every preventive measure imperative. 

Smallpox, thanks to compulsory vacci- 
nation, is seen so rarely that it need not 
be considered here. 

SCARLET FEVER 

Scarlet fever is one of the most im- 
portant of the contagious diseases, and 
whether a case is mild or severe it re- 
quires the greatest watchfulness on the 
part of both physician and nurse, nor can 
their vigilance be safely relaxed until the 
patient has been apparently well for at 
least five or six weeks. The period of 
incubation varies considerably. In the 
majority of cases the first sign of trouble 
is noticed from three to five days after 
exposure. In one of my cases twelve 
days elapsed between the time of ex- 
posure and the initial symptom. If, how- 
ever, nine days pass without evidence of 
illness, the child may ordinarily be con- 
sidered safe, but the exposed should not 



Scarlet Fever 145 

come in contact with other children until 
at least fourteen days have elapsed. In- 
fection usually takes place from direct 
contact, although the contagium, the 
nature of which is unknown, may be 
carried by means of clothing, toys, books, 
or a third person. Doctors who do not 
wear gowns while attending scarlet fever 
patients, and are careless about washing 
their hands after examining such cases, 
may themselves carry the disease. One 
attack usually protects against a second, 
although cases are on record of the 
occurrence of two or three attacks in 
the same individual. 

The onset of scarlet fever is sudden, 
often with vomiting, occasionally with a 
convulsion, always with fever and sore 
throat. The fever is usually high, 103 
to 105 F., though it may be low, — 101 to 
102 . When the latter is the case the 
course of the disease will probably be mild. 
Whether the fever is high or low, the 
deeply red, congested throat is always 
present. From twenty-four to thirty-six 
hours after the initial symptom the rash 



H 6 Scarlet Fever 

makes its appearance. In many mild 
cases it will be the first symptom noticed. 
The character of the rash, its intensity, 
and the height of the fever indicate fairly 
well the severity of the attack. The 
chest and abdomen are usually the site 
of the first appearance of the rash. It is 
composed of minute red dots so closely 
set together as to give the skin a deep 
scarlet color. The extent of the rash 
varies greatly ; in some cases it covers 
the entire body and lasts from six to 
seven days. In others, it is much less 
distinct, covering only limited areas, and 
may last for only a few hours. In one 
of my cases it was visible for only six 
hours after it was first noticed ; while in 
all other respects the case was one of 
typical scarlet fever. Ordinarily the rash 
begins to fade about the fourth or fifth 
day and is followed by the desquamation 
period. This is also variable in extent ; 
there may be but a slight peeling of the 
palms of the hands, and of the finger-tips 
about the nails, or it may be most pro- 
fuse, the epidermis peeling off in large 



German Measles H7 

flakes from the entire surface of the 
body. From two to three weeks are 
required to complete this process. 

Complications are a common occur- 
rence in scarlet fever, and it is the com- 
plications which are usually the cause of 
death in the fatal cases. The kidneys, 
heart, lungs, and ears are particularly 
liable to serious involvement. 

An error frequently made is to allow 
the child convalescent from scarlet fever 
to be out of bed too early. He should 
never be allowed to run about before 
four, or, better still, five or six weeks 
have elapsed. The peeling may be 
hastened, the disease curtailed, and the 
danger of spreading lessened by a daily 
sponge bath followed by an inunction 
with sweet oil or vaseline. 

GERMAN MEASLES 

German measles is a contagious disease 
of a very mild type, ordinarily the rash 
being the first sign of illness. This may 
have been preceded, however, by a slight 
chilliness and soreness of the muscles. 



1 48 Mumps 

The eruption is of a reddish-brown color 
and appears more extensively on the face 
and chest than on other parts of the body. 
The spots vary in size from a pin-head 
to a flaxseed. In well-developed cases 
the rash may cover the entire surface of 
the body. The temperature is usually 
low and lasts but a day or two. I have 
never seen it above 102 F. There is 
little or no inflammation of the eyes, 
nose, or throat, in marked contradis- 
tinction to measles. There is no cough 
and the child suffers very little inconven- 
ience. The glands behind the ear and 
at the sides of the neck are always en- 
larged and sensitive, — this with the fever 
and the rash comprising the chief symp- 
toms of the disease. The duration of 
the rash varies from one to three days. 
Usually at the end of forty-eight hours 
the skin will be found clear. 

My treatment is : two or three days in 
bed and a light diet. 

MUMPS 

Mumps is an inflammation of one or 



Mumps 149 

both parotid and sublingual glands. One 
attack usually protects against another. 
The disease is usually acquired by contact 
with the infected. It is extremely doubt- 
ful that it can be carried by a third party. 
The period of time required for the de- 
velopment of the disease after exposure 
varies considerably ; but from two to three 
weeks may be considered the period of 
incubation. 

The first symptoms are similar to those 
of the other contagious diseases. There 
are loss of appetite, headache, languor, 
and slight fever. In addition to these 
general symptoms, the child complains 
of pain upon swallowing, or upon moving 
the jaw. Vinegar or any acid substance 
taken into the mouth causes considerable 
pain or discomfort behind the jaws and 
under one ear. In a few hours there will 
be noticed a swelling of the parotid gland 
in front of and under the ear. Both sides 
rarely begin to swell at the same time ; 
the swelling of one gland usually pre- 
cedes that of the other by a couple of 
days. It increases gradually for two or 



150 Mumps 

three days until it reaches its height, when 
it begins to subside slowly, reaching the 
normal in eight or ten days from its be- 
ginning. The temperature during the 
attack ranges from ioo° to 103 F. 

The complications of mumps in chil- 
dren are few, and the disease cannot be 
regarded as dangerous. Acute Bright's 
disease followed an attack of mumps in 
one of my patients. Swelling of the 
testicles is a comparatively rare occur- 
rence. Ear disease is an infrequent but 
possible complication. Multiple abscesses 
may develop in the parotid gland, but 
this is also a very rare occurrence. Other 
acute glandular swellings at the angle of 
the jaw are often mistaken for mumps ; 
in mumps, however, the swelling is always 
in front of, under, and behind the ear. A 
simple glandular enlargement may be lo- 
cated at any point under or behind the 
jaw. 

A child with mumps should be kept in 
bed until the swelling has subsided, and 
given plain, easily digested food. The 
mouth should be rinsed after each meal 



Whooping-Cough 1 5 l 

with a saturated solution of boracic acid. 
For the pain and discomfort caused by 
the swelling, hot applications answer best. 
Flannel wrung out of very hot water and 
bound upon the parts always furnishes 
some relief. The flannel should be kept 
hot by repeatedly dipping it into hot water. 
The heat will be retained better if the 
flannel is covered with oiled-silk. 

WHOOPING-COUGH 

In whooping-cough we have one of 
the most dangerous diseases of childhood, 
dangerous in the extreme for the very 
young, the delicate, and the rachitic. In 
itself it is seldom directly fatal, but the 
frequent complications of catarrhal pneu- 
monia in winter and intestinal diseases 
in summer make it indirectly responsible 
for the loss of many lives. 

The period of incubation ranges from 
seven to fourteen days. At the com- 
mencement of the disease the cough is not 
severe and often cannot be distinguished 
from that of bronchitis or a common 
cold. The cough, however, does not re- 



1 5 2 Whooping-Cough 

spond to treatment for coughs and colds ; 
it increases in severity, becoming par- 
oxysmal in character and worse at night. 
During the paroxysms the eyes water, 
the face becomes red and congested, the 
seizure often ending in vomiting. The 
characteristic whoop usually develops after 
ten days or two weeks. In the mild cases 
there may be but two or three paroxysms 
daily ; in the severe cases there are usu- 
ally from twenty to thirty in twenty-four 
hours. I have seen a few cases in which 
the disease was so mild that the whoop 
never appeared, while others whooped 
but once during an entire attack. The 
disease varies not only in its severity, but 
in its duration as well. Occasionally cases 
are seen which run the entire course in 
four weeks ; unfortunately, they are rare. 
As a rule, from eight to ten weeks elapse 
before the child may be considered well. 

As long as the child continues to whoop, 
or the cough is distinctly paroxysmal, it 
is not safe for him to come in contact 
with the unprotected. The active stage, 
during which the paroxysms are frequent 



Diphtheria 153 

and severe, rarely lasts longer than two 
or three weeks. Sometimes after a period 
of three or four months without whoop- 
ing, the child takes cold, develops a cough 
paroxysmal in character, and the whoop 
returns ; but this does not mean that there 
is a return of the whooping-cough, and 
such children need not be quarantined. 

Whooping-cough cannot be cured ; it 
must run its course. The author's ob- 
servations, which cover the management 
of 768 cases, prove that every case may 
be ameliorated and its course perhaps 
shortened. The home treatment de- 
mands an abundance of fresh air. The 
child should spend the greater part of 
every pleasant day out of doors and sleep 
with the window open an inch or two 
from the top, regardless of the weather. 

DIPHTHERIA 

Diphtheria is a disease due to a germ 
which is known as the Klebs-Loeffler 
bacillus. It lodges upon the mucous 
membrane of the throat or nose, and there 
starts up a process known as diphtheria. 



154 Diphtheria 

The disease is usually of slow and insidi- 
ous onset, requiring two or three days 
for its complete development. The pe- 
riod of incubation varies greatly ; a child 
may develop diphtheria within twenty- 
four hours after exposure, or it may be 
delayed a month or six weeks. In children 
who have been exposed, there should be 
a microscopical examination of the secre- 
tion from the throat, which may settle the 
question as to the child's liability to con- 
tract the disease. 

The first symptoms are fever and rest- 
lessness, loss of appetite, and disinclination 
to play. The child may complain of pain 
upon swallowing, and in many cases, very 
early in the attack, swelling may be 
noticed at the angle of the jaw. Inspec- 
tion of the throat shows the characteristic 
patches of the membrane. In some cases 
these patches resemble a thin layer of 
putty spread over the parts. Others 
present the appearance of a very light- 
yellow paint splashed upon the tonsils 
and adjacent parts. The membrane 
may be located in the nose, throat, 



Diphtheria 155 

larynx, eye, — in fact, any mucous surface 
may become infected ; fresh wounds may 
also become infected. The usual sites, 
however, are the nose, throat, and larynx. 
The disease may be transmitted by direct 
contact, by means of contaminated cloth- 
ing, toys, pictures, books, or the germs 
may be carried on the hands or clothing 
of an attendant. 

One attack does not protect against 
another. There is evidence that a cer- 
tain degree of immunity is established, 
but it probably is not effective for more 
than a few months. Diphtheria does not 
run a definite course, like the other in- 
fectious diseases. We cannot say that 
certain definite signs will be present on 
certain days. It is the most uncertain 
and treacherous disease with which we 
have to deal. 

The only treatment of value other than 
supportive measures is the use of anti- 
toxin, which must be given early in the 
disease — as soon as a diagnosis of diph- 
theria is made. In fact, I believe it is 
advisable to give it in all cases where there 



15 6 Diphtheria 

is any uncertainty as to whether the case 
is tonsillitis or diphtheria. Much valuable 
time may be lost by delay. The antitoxin 
should be repeated in from twelve to 
twenty-four hours if improvement does not 
follow. I have been obliged in two cases 
to give three injections of 2000 units each. 
In the majority of my cases two injections 
of 2000 units each were required. 1 No 
harm results from the use of antitoxin. I 
have employed it in thirty-three cases and 
have lost but two. One child I did not see 
until the fourth day of its illness, which 
was too late for the antitoxin to be of 
any service. Dr. W. B. Hoag, of New 
York, has employed antitoxin in over 
thirty consecutive cases without a death. 
Other physicians can doubtless show 
equally brilliant results. The general 
mortality of diphtheria has been markedly 
reduced through its use. During conva- 
lescence, the child must not be allowed to 
mingle with other children until a bacterio- 

1 In the very severe cases in which there is early involve- 
ment of the nose or larynx, from 3000 to 5000 units should 
be given at the first injection. 



Chicken-Pox 157 

logical examination of the throat shows it 
to be free from diphtheritic germs. 

The instructions for the preparation of 
the sick-room, for disinfection and quar- 
antine, will be found on pages 162-164. 

CHICKEX-POX 

Chicken-pox is one of the milder con- 
tagious diseases. Among several hun- 
dred cases I have seen but two that were 
severe enough to endanger life. 

The period of incubation is quite long, 
— from fourteen to twenty-one days. 
There is slight fever at the onset, rarely 
high enough, however, to be noticed by 
the mother or nurse. More frequently 
the first sign of the disease is the char- 
acteristic eruption which may appear on 
any portion of the body, the scalp some- 
times being particular!}- involved. The 
rash consists of very small blisters which 
from a distance give to the skin the ap- 
pearance of having been sprinkled with 
water. The fluid soon disappears, leav- 
ing a dark-colored crust. When the 
crusts fall, a small scar is often left, which 



158 Measles 

may remain for several months. In an 
ordinary case the skin will not be clear 
before the end of the third or fourth week. 

The child should be kept indoors dur- 
ing the attack, and given a reduced diet. 
The itching is often relieved by sponging 
with a weak solution of alcohol in water, — 
four ounces to a pint, followed by a gen- 
tle application of vaseline. 

I never advise quarantine against chick- 
en-pox except to avoid the needless ex- 
posure of very young or delicate children 
in the family. The patient should not 
return to school or be allowed to mingle 
with other children — in short, is not 
to be considered well until the skin is 
clear. 

MEASLES 

The incubation period of measles — the 
time required between the exposure and 
the development of the first symptom — 
varies between nine and twelve days. One 
attack usually protects against a second. 
This, however, is not invariably the case. I 
have a patient, a young girl, eighteen years 



Measles 159 

old, who contracts measles every time she is 
exposed. She recently passed through her 
fourth attack, which was most severe. 

The onset of the disease closely re- 
sembles that of a common cold. The 
symptoms are slight fever, ioo°-io2° F., 
redness of the eyes and intolerance of 
light, a watery discharge from the nose, 
a dry, hard cough, pain on swallowing, and 
loss of appetite. The peculiar swollen, 
congested condition of the eyes and face 
often makes a diagnosis possible before 
the appearance of the rash. This usually 
first appears from the second to the fourth 
day of the illness, upon the face and chest. 
At first there are small, irregularly shaped 
spots said to resemble fleabites. The 
spots coalesce, the rash extends, and in 
one or two days the greater portion of 
the skin is involved. The rash remains 
at its height for two or three days, when 
it begins to fade, and in two or three 
days more the skin becomes clear. With 
the subsidence of the rash, desquamation 
or peeling of the skin begins. This con- 
sists in the shedding of fine, thin scales. 



160 Measles 

The fever and prostration keep pace fairly 
well with the rash. The fever, which may 
range between 102 and 105 , reaches its 
highest point with the complete develop- 
ment of the rash. With the fading of the 
rash the fever also moderates. The cough 
in measles is hard and dry in character 
and is often quite severe. It must be re- 
membered that the congestion of the res- 
piratory mucous membrane which causes 
the cough is a part of the disease. The 
cough may be relieved, but it will not 
subside until the disease has run its course. 
There is always considerable involvement 
of the eyes, the lids being red and swollen, 
with a free secretion of watery mucus. 
In many families but little attention is 
paid to measles — it is regarded with more 
or less indifference. While, in most in- 
stances, the disease may not be particu- 
larly dangerous, we must remember that 
it is sometimes quite virulent, and domes- 
tic treatment should never be relied 
upon. There is always more or less 
bronchitis, which in young and delicate 
infants constitutes a severe complication, 



Measles 161 

leading, as it often does, to catarrhal 
pneumonia. 

The eyes should be washed daily with 
a saturated solution of boracic acid. Their 
sensitive condition requires also a dark- 
ened room, and failure to appreciate this 
fact has often resulted in their permanent 
injury. A darkened room, however, does 
not mean a room devoid of ventilation ; 
fresh air for a patient with a contagious 
disease is almost as important as nourish- 
ment. The diet must be simple ; only fluid 
diet should be given to " runabouts," while 
for infants the usual milk mixture should 
be diluted with boiled water from one- 
third to one-half. The child should 
have a lukewarm sponge bath every 
day, followed by an inunction of vase- 
line, which not only relieves the itching, 
but renders the patient much more com- 
fortable. 

Children convalescent from measles 
should not be allowed to go to school or 
mingle with the unprotected until two 
weeks after the completion of desqua- 
mation. 



1 62 The Sick-Room 

SICK-ROOM FOR CONTAGIOUS DISEASES 

QUARANTINE 

A child ill with a contagious disease 
should always be isolated, whether there 
are unprotected children in the family or 
not. Quarantine can be carried out only 
when the child is placed in a room alone 
with the nurse or mother, and neither 
allowed to leave the room or in any way 
to come in contact with other members of 
the family. If possible the room should 
be on the top floor of the house. The 
furniture should be of the simplest, — no 
fancy curtains and no upholstery. A 
perfectly bare floor is best. If two 
nurses are required, two isolating rooms 
will be necessary, one to be used as a 
sleeping-room. The meals should be 
carried on a tray and placed upon a chair 
outside the closed door of the isolating 
room. The dishes containing the food 
are to be removed by the person isolated. 
After use, before returning the dishes to 
the chair outside the door, they should be 
placed for five minutes in boiling water. 
Only wash goods should be worn by the 



The Sick-Room 163 

attendants, and their clothing, with bed 
linen when changed, should be placed in 
boiling water — one ounce of carbolic acid 
to two gallons of water — before it is sent 
to the laundry. 

When other members of the family are 
allowed to go at will into and out of the 
isolating room, the value of the quaran- 
tine is practically lost. If the illness is of 
a serious nature, such as scarlet fever or 
diphtheria, the other children of the family 
should be sent to other quarters ; particu- 
larly should this be done . if the family 
occupy an apartment. 

DISINFECTANT DRUGS. 

The erroneous views possessed by many 
concerning disinfection often result in 
much harm. Too many are satisfied by the 
use of disinfectant solutions and drugs at 
the expense of cleanliness. Any agent that 
will destroy germs is a disinfectant. Dis- 
infection really means cleanliness. Dis- 
infectants can never supplant hot water, 
common yellow soap, and a nail-brush. 
Dipping the hands into a solution of car- 



164 Disinfection 

bolic acid or bichloride of mercury will 
not make them clean, much less sterile. 
Sprinkling either of these substances upon 
the floor will not clean the floor or be of 
one particle of service. Scrubbing the 
floor of the sick-room once a day, using 
hot water, sapolio, and a stiff brush, will 
do more to prevent the circulation of the 
germ-laden dust than any disinfectant 
which can be used. I recently saw a 
young mother change the baby's napkin, 
immediately after which, with hands un- 
touched by soap or water, she very care- 
fully washed out the baby's mouth with 
the boracic acid solution ! The young 
mother was anxious to do her full duty 
by the child, but had never learned the 
rudiments of disinfection. 

Disinfectant solutions and drugs are of 
much service when used after a thorough 
scrubbing with hot water, soap, and brush, 
— never before. 

DISINFECTION AFTER CONTAGIOUS 
DISEASES— FUMIGATION. 

Before being allowed to resume his 
place in the family, the child who has 



Fumigation 165 

recovered from a contagious disease 
should be given a tub bath, with a vigor- 
ous scrubbing with soap and warm water. 
The hair should be washed with a 1 to 2000 
solution of bichloride of mercury, and the 
child dressed in fresh clothing outside 
the sick-room. 

The soiled clothing and the bedding 
which can be washed should be put into 
a solution of one ounce of carbolic acid 
to two gallons of water. The vessel 
should be covered and removed to the 
laundry and the clothing boiled thirty 
minutes. The bedding and such articles 
as cannot be washed should be spread 
over the furniture in readiness for fumi- 
gation. 

The windows and doors must be closed 
and sealed, when the room can be fumi- 
gated with sulphur or formalin. If sulphur 
is used, three pounds of roll sulphur are 
required by the New York Health De- 
partment for every thousand cubic feet 
of air space. The sulphur is placed in 
an iron vessel which, as a precaution 
against fire, should stand on a large sheet 



1 66 Fumigation 

of tin or zinc. Alcohol is poured over 
the sulphur and ignited, after which the 
room should not be opened for twenty- 
four hours: If the air in the room can 
be charged with a moderate amount of 
vapor from an open vessel on a stove or 
radiator, the sulphur disinfection will be 
more complete. Formalin acts as a much 
better disinfectant and is far less objec- 
tionable than sulphur. The formalin ap- 
paratus with directions for its use can be 
rented at a moderate price from most 
New York druggists. 

After the fumigation, the carpet or 
rugs, mattresses, and pillows are taken 
charge of by the health authorities in 
the larger cities, steamed, and returned in 
two or three days free of expense to the 
owner. Otherwise such articles should 
be sent to the cleaner and the mattresses 
and pillows re-covered. The floor of the 
room and the woodwork should be 
scrubbed with hot water, brush, and soap. 
When dry they should be washed with a 
i to 2000 solution of bichloride of mercury. 
The furniture should also be washed with 






Glands 167 

the bichloride solution. If the walls are 
papered, they should be wiped with cloths 
moistened with this solution ; but it is 
better to have the room re-papered. If 
the walls are painted, they should be 
washed with the solution. If the walls 
can be newly papered, painted, or kalso- 
mined, much greater security will be 
enjoyed by the future occupant. 

GLANDS 

ACUTE ENLARGEMENT OF THE GLANDS OF 
THE NECK 

A mother is often alarmed by the sud- 
den appearance of a hard swelling in the 
neck of one of the children. The swelling 
may appear during the night and in- 
crease greatly in size for a day or two, 
when it may be as large as a horse- 
chestnut. Such a condition is due to 
swollen lymphatic glands, which are 
usually situated just behind the jaw and 
below the ear. Occasionally the swellings 
may appear in the soft parts under the 
jaw. The glands, in the performance of 
their functions, have become infected and 



1 68 Glands 

the swelling follows. The cause of the 
infection will usually be found in a le- 
sion of the mouth or throat. It may 
sometimes be traced to a lesion of the 
skin in the neighborhood of the swelling. 
Thus, the source of infection may be a 
decayed tooth, a simple abrasion of the 
mucous membrane, or an acute inflam- 
mation of the parts, such as tonsillitis 
or pharyngitis. In scarlet fever and in 
diphtheria the glands are often seriously 
involved. The glandular enlargements, 
however, which appear suddenly, inde- 
pendent of serious illness, need cause no 
great anxiety. They terminate usually in 
one of two ways : they gradually disap- 
pear under treatment or they break down 
and form an abscess which requires in- 
cision and drainage. In either event 
complete recovery follows. 

If the swellings occur in diphtheria or 
in any other infectious disease, they may 
constitute a grave complication. With 
their first appearance, apply cold com- 
presses to the parts constantly until the 
physician arrives. 



The Skin in Health 169 

CHRONIC ENLARGEMENT OF THE GLANDS OF THE 
NECK 

The lymphatic glands of the neck may 
be chronically enlarged as a result of tu- 
berculosis, syphilis, or local infections from 
the skin, and a lowered general vitality. 

The mother usually notices a slight 
swelling of the parts, which, upon touch, 
gives the impression of a hard round 
body immediately beneath the skin ; usu- 
ally several of these nodules will be dis- 
covered. They often extend in chains 
down the side of the neck ; sometimes 
both sides will be involved. Bunches of 
glands may also appear under the ear 
,and at the angle of the jaw. They vary 
in size from a buckshot to a butternut. 

Children with a tendency to enlarge- 
ment of these glands should be constantly 
under medical supervision. 

THE SON IN HEALTH 

The skin of an infant is extremely deli- 
cate and great care is required to keep it 
in a healthy condition. The secret of a 
healthy skin in an infant is in proper 



1 70 Eczema 

attention. It must be kept clean and dry. 
After the daily bath, in which no ingredi- 
ent other than plain boiled water and 
Castile soap should enter, the baby must 
be carefully dried and the folds of the 
skin and flexures of the joints thoroughly 
powdered with equal parts of oxide of zinc 
and powdered starch. When the napkins 
are soiled they should be changed at once 
and the parts again washed and pow- 
dered. An occasional sponging, followed 
by a generous use of powder during 
very hot weather, will often prevent an- 
noying skin affections, such as prickly 
heat and eczema. 

ECZEMA 

Eczema, a catarrhal inflammation of 
the skin, is a disease to which young chil- 
dren are very susceptible. It appears in 
different forms, which means that there 
are several varieties of the disease. Any 
portion of the skin surface may be in- 
volved. The parts most frequently affect- 
ed are the scalp, cheeks, forehead, and the 
flexures of the joints, where the skin sur- 



Eczema 171 

faces come in contact. The causes of 
eczema may be from within or without. 
The external causes are all of the na- 
ture of irritants. A baby's skin is very 
delicate, and trifling causes will often 
produce a great deal of inflammation. 
Strong soaps, liniments, a sudden ex- 
posure of the moist skin to cold air, ex- 
cessive perspiration, insufficient bathing, 
discharge from the ear or nose, all may 
cause a local irritation and produce the 
disease. Allowing a child to rest in a 
soiled napkin is a most frequent cause of 
eczema of the buttocks, a condition which 
is elsewhere referred to. The treatment 
of this type of the disease resolves itself 
into removing the cause and protecting 
the parts by means of a suitable ointment 
or powder. 

Among the internal causes, indigestion 
is by far the most frequent. It is not the 
delicate child who suffers most from 
eczema. In many instances the robust 
nursling and the vigorous bottle-fed baby 
are the sufferers. The child in other 
respects appears well, has a good appetite, 



17 2 Hives 

is bright and happy, and shows normal de- 
velopment. The bright red and some- 
times weeping area on each cheek, and 
the itching, scaly forehead, show clearly 
that something is wrong, and the error 
will usually be found in the gastrointes- 
tinal tract. The food in some respect is 
unsuitable, not being properly adapted to 
the child's digestive capacity. In the 
breast-fed, regulation of the life of the 
mother as regards her diet, exercise, and 
bowel functions will often effect a cure. 
In the bottle-fed, an adjustment of the 
food to the child's age and digestive ca- 
pacity aids materially in the treatment. 
Constipation, if present, must be relieved. 
Local treatment with ointments, washes, 
and powders are all of little value if the 
cause of the disorder is not removed. The 
case may improve temporarily under the 
local treatment, but within a few days 
the inflammation reappears in full force. 

HIVES 

The type of hives most frequently seen 
in children appears in the form of large 



Hives 173 

wheals from one-half to one inch in di- 
ameter. There may be but two or three 
of these wheals, or a large portion of the 
body may be covered by them. They 
consist of a firm, flat, circumscribed, red- 
dened eruption of the skin, without any 
definite arrangement. In addition to the 
skin, the mucous membrane of the tongue, 
mouth, and pharynx may be involved. 
In some instances the eruption appears 
very suddenly, lasts but a few hours, and 
quickly disappears. If the attack is of a 
severe nature new spots appear from time 
to time which behave in the same way. 
Hives in children are almost without ex- 
ception due to digestive disorders. I 
have repeatedly known attacks to follow 
some unsuitable article of diet, such as 
cakes, strawberries, pastry, or nuts. Con- 
stipation may cause an attack. 

The only symptom of consequence is 
the distressing itching which is always 
present. Treatment consists in the use 
of laxatives and a temporary restricted 
diet. The itching is best relieved by 
bathing the parts with a solution of 



1 74 Milk-Crust 

carbolic acid — one teaspoonful to a pint of 
water. 

MILK-CRUST 

What is commonly known as milk-crust 
consists of the formation on the scalp of 
a thick layer of yellow sebaceous material. 
In addition to being unsightly it is very 
annoying to the patient on account of 
the itching which it causes. The mother 
usually assures us that the condition is 
not due to neglect. The head is washed 
and oiled very often ; but washing will 
neither cure nor prevent the disease. 

Milk-crust is due to an inflammation of 
the sebaceous glands of the skin. The 
affection is easily relieved. The hair 
must be cut very short, and an ointment, 
composed of resorcin, thirty grains, and 
vaseline, two ounces, should be spread 
generously over the diseased area and 
covered with a piece of linen which has 
been saturated with the ointment. Over 
this a fairly tight-fitting, home-made mus- 
lin cap should be worn to hold the dress- 
ing in place. The ointment should be 



Intertrigo 175 

applied twice daily. After three or four 
days of the treatment, during which time 
no water must touch the scalp, it may be 
gently cleansed with Castile soap and 
warm water, or with warm sweet oil. 

The whole or the greater portion of 
the crusts may be removed with the first 
washing. Some severe cases may require 
two or three repetitions of the treatment. 
After the scalp is clean, an application of 
the ointment at bedtime once or twice 
a week will prevent a return of the 
trouble. 

INTERTRIGO 

Inflammation of the skin of the thighs 
and buttocks, by some mothers errone- 
ously called sprue, is often seen in quite 
young children. In the majority of cases 
this condition is due solely to neglect of 
the toilet. The child is allowed to lie 
in soiled napkins, the irritant discharges 
thus remaining in contact with the delicate 
skin, and inflammation and excoriation of 
the parts naturally follow. Children have 
delicate skins and often pass very acid 



176 Intertrigo 

urine. When this combination is present 
an inflammatory condition of the parts is 
frequently difficult to avoid. The man- 
agement is simple, usually requiring only a 
changing of the napkin as soon as soiled 
and the generous use of zinc ointment. 
I have had very little success with dust- 
ing powders in such cases, especially in 
those of any degree of severity. After 
a passage either from the bladder or 
bowels, the napkin should be immediately 
removed, the parts gently washed with 
Castile soap and boiled water, or, in bad 
cases, warm sterilized sweet oil may be 
used to better advantage. After the parts 
are clean, apply to the inflamed area 
pieces of clean old linen which have been 
covered with zinc ointment. If the oint- 
ment is applied directly to the skin the 
napkin soon absorbs it, and its application 
will be of no service. The ointment acts 
as a barrier between the irritating pas- 
sages and the inflamed skin. Under this 
treatment I have repeatedly seen the 
worst cases of intertrigo recover in a 
week. 



Prickly Heat 177 

Of course the applications must be 
repeated after each cleansing and dry- 
ing. The ointment must be used ex- 
travagantly. 

PRICKLY HEAT 

There are very few infants who at some 
time during the hot months do not suffer 
from prickly heat. This eruption, which 
is caused by excessive perspiration, con- 
sists of very small, pale-red papules, 
which appear most prominently over the 
shoulders, chest, and abdomen, although 
the entire surface of the body may be 
covered. The great majority of children 
are over-clad in summer — the clothing 
is too thick and there is too much of it. 
At the out-patient department of the 
Babies' Hospital I see hundreds of cases of 
prickly heat every summer, due largely to 
excessive clothing. It may seem strange, 
but, as a rule, the poorer the mother, 
the more clothing she puts on the baby. 

Considerable relief may be given these 
children by the use of a bicarbonate 
of soda bath, — a heaping teaspoonful to a 



1 78 Fissures of the Anus 

gallon of water. After the bath, a pow- 
der composed of powdered boracic acid, 
twenty grains, powdered starch and 
oxide of zinc, each one-half ounce, should 
be thoroughly dusted over the affected 
surface. The powder may be used sev- 
eral times a day independent of the bath. 
The clothing should be very light and 
loose ; thin cottons should be worn in- 
stead of woollen goods. 

FISSURES OF THE ANUS 

In children suffering from what are 
called fissures of the anus, there will be 
found one or more slight tears in the 
mucous membrane just inside the anal 
aperture. In such cases there is always 
a history of an intestinal disorder, usually 
constipation, sometimes diarrhoea, the 
fissures having been caused either by a 
stretching of the parts by a hard, consti- 
pated movement, or by the frequent 
irritant passages which have caused a 
destruction of the mucous membrane of 
the parts. 

An infant thus affected cries lustily 



Boils 1 79 

when having a passage, and strains and 
presses for some time afterward. Very 
often the passage will be streaked with 
blood. Older children postpone going 
to stool as long as possible and complain 
greatly of pain when the bowels move. 

These cases will be greatly relieved by 
the correction of the intestinal derange- 
ment. If the child is constipated, the 
movements should be kept soft by the 
use of suitable diet and laxatives. If 
there is diarrhoea, suitable diet and medi- 
cal treatment are necessary. The local 
treatment, which may be necessary, should 
be carried out by a physician. 

BOILS 

Infants are particularly subject to boils, 
which are supposed by many to indicate 
some radical blood disorder. As a re- 
sult, the victims are drugged and purged 
with all sorts of teas and "blood-puri- 
fiers." The cause of the boil is very 
rarely from within. It is usually the 
result of a local infection or inoculation 
into the skin, the germs finding entrance 



180 Boils 

by means of a hair follicle or an abrasion 
so small as to be invisible to the naked 
eye. A boil having formed, the pus is 
carried to other portions of the skin by 
the lymphatics, or it escapes upon the 
surface, and, in either case, other portions 
of the skin are inoculated, and a series 
of boils results. The parts most often 
involved are the head, the neck, and the 
shoulders, although they may appear 
upon any portion of the body, with the 
exception of the palms of the hands 
and the soles of the feet. I have 
opened one hundred and four on one 
child during a period of three weeks. 
While boils are more frequently met 
with among the debilitated and weakly, 
they are by no means uncommon in the 
strong and otherwise well. Poulticing, 
and allowing a boil to open spontane- 
ously, is calculated to prolong the trouble 
indefinitely. A boil should be opened 
early, the pus evacuated, and the sur- 
rounding skin thoroughly washed with 
soap and water, when an antiseptic dress- 
ing composed of several thicknesses of 



Head Lice, or Pediculi Capitis 181 

old linen, which has been boiled and dried 
and then dipped into a saturated solution 
of boracic acid, answers every purpose. 
Not only the boil but the adjacent skin 
for several inches must be covered by the 
dressing, which is to be kept wet with the 
boracic acid solution. 

BURNS 

The temporary treatment of a burn of 
any degree aims at the exclusion of the 
air by the application to the injured parts 
of some non-irritating, oily substance, 
such as vaseline, zinc ointment, or steril- 
ized sweet-oil. A piece of clean linen is 
saturated with the ointment and placed 
upon the parts affected, and the dressing 
changed every two hours until the arrival 
of the physician. 

HEAD LICE, OR PEDICULI CAPITIS 

Head lice, or pediculi capitis, are very 
frequently seen in out-patient and hos- 
pital work in all the larger cities. Occa- 
sionally other children become infected in 
school or in public conveyances. The 



1 82 Bites of Insects 

most successful and cleanly treatment con- 
sists in cutting the hair short ; this done, 
wash the head with soap and water once 
a day, and after drying moisten the scalp 
thoroughly with the following solution : 

Acetic Acid 2 drachms. 

Sulphuric Ether 3 ounces. 

Tincture of Larkspur 4 ounces. 

Alcohol 4 ounces. 

Improvement will follow a few treat- 
ments. The pediculi will be killed and the 
nits may be removed with a fine-tooth 
comb. If the patient is a girl it is not 
absolutely necessary to sacrifice the hair. 
It may be parted from various portions of 
the scalp and the solution applied without 
previous washing. However, if the hair 
is not cut, a much longer time will be 
required to effect a cure. 

BITES OF INSECTS 

Bites of insects are rarely dangerous, 
although they sometimes cause great tem- 
porary disfigurement. It is quite difficult 
often to distinguish between insect bites 



Bites of Animals 183 

and the eruption of hives. Mosquitoes 
poison some infants severely. 

Insect bites are best treated by the 
use of a solution of carbolic acid, — one-half 
teaspoonful to a pint of water. This is 
applied by means of old linen which is 
kept saturated with the solution. 

BITES OF ANIMALS 

Bites of animals rarely amount to more 
than an incised wound from any other 
cause, and the treatment required is prac- 
tically the same. When a child is bitten 
by a dog or a cat the parents are greatly 
alarmed lest the child develop hydropho- 
bia. If, however, they will believe that this 
disease exists chiefly in the minds of the 
individuals interested in its treatment, if 
they will believe that dogs bite thousands 
of people every year and no harm comes 
from it, if they will believe that mad dogs 
are about the scarcest thing on earth, 
they will waste much less good nerve 
force upon what is usually a trifling mat- 
ter. In case of a bite of any animal, dis- 
solve one teaspoonful of carbolic acid in 



1 84 Fever 

one pint of water, and keep the parts moist 
with the solution, using only clean linen 
for its application to the wound. The 
physician, who should be called at once, 
will advise further treatment if needed. 

FEVER 

By fever we understand an elevation of 
the temperature of the body above the 
normal, which in an infant is 99 F -f by 
rectum. Fever, however, does not con- 
stitute disease. It is nothing more or less 
than a symptom, but it always means that 
something is wrong with the baby. It may 
be due to a slight attack of indigestion, the 
eruption of teeth, or to the beginning of 
scarlet fever, diphtheria, or some other 
disease. Children develop fever much 
more readily than adults, and it is of less 
significance in them. A child with fever 
that is appreciable to the touch of the 
mother will usually register a temperature 
of ioo.5°-ioi.5°. While such a temper- 
ature is by no means alarming, its cause 
should be discovered. In the absence of 
a clinical thermometer, in order to examine 



Fever 185 

a baby for fever, place upon the abdomen 
the palm of a hand which has been previ- 
ously warmed. Examination of a child's 
hands, head, and feet furnishes us very 
inexact means of judging as to the ques- 
tion of fever. Many times these parts 
will be cold when the thermometer regis- 
ters a temperature of 104 or 105 . Every 
young mother should possess, and know 
how to use, a clinical thermometer. In 
case of sudden high fever, — 104 to 105 , 
from any cause, the mother cannot make 
a mistake in giving an alcohol and water 
sponge bath at a temperature of 85 F. 
One part of alcohol may be added to fif- 
teen of water and the child sponged for 
twenty minutes. If necessary the spong- 
ing may be repeated every two or three 
hours ; this will keep the child comfortable 
ttntil the arrival of the physician and per- 
haps prevent unpleasant complications. 
In case of fever the nourishment should 
always be reduced at once ; if the child is 
on the bottle, reduce the strength of the 
food one-half by the addition of boiled 
water. If the child is nursed, reduce the 



1 86 Malaria 

duration of each nursing period one-third. 
Children with fever can always have plenty 
of cold boiled water to drink. Mothers 
must remember that it is not the fever 
per se, but the condition of the patient, 
which governs us in our treatment. In 
scarlet fever and pneumonia a temperature 
of io2° to 104 is expected, and need 
cause no alarm. 

MALARIA 

Children in New York City and vicinity 
frequently suffer from malarial fever. 
Many cases come under my observation 
every year, both in out-patient and pri- 
vate practice. The disease manifests it- 
self in three different sets of symptoms. 
The mild form is most frequently seen, 
and will be first considered. 

The first signs of the illness are drowsi- 
ness, languor, disinclination to play, and 
loss of appetite. In addition, such a child 
is apt to be peevish and fretful ; he falls 
asleep at unusual times during the day. 
The sleep at night is often disturbed, 
and he generally sleeps later in the morn- 



Malaria 187 

ing. There is a little fever, — so slight that 
it is not appreciable to the touch. These 
symptoms are followed by pallor and loss 
of weight. Such a condition may exist for 
several weeks without the development 
of more active symptoms of the disease. 

In the more typical cases, the fever, 
languor, and drowsiness will appear at a 
definite time each day, — usually from 
three to five o'clock in the afternoon. 
The child wakes the following morning 
apparently well, but at about the same 
hour in the afternoon the symptoms are 
repeated. There is always a distinct peri- 
odicity in the symptoms. In some cases 
the child will be ill every second day, but 
at the same hour. In other cases the 
symptoms are still more characteristic and 
are easily recognized. At a certain time 
every day, or perhaps every seconjd or 
third day, there will be a chill and a rapid 
rise in temperature, followed by a pro- 
fuse perspiration, during which the fever 
subsides. 

I recently treated a little girl five years 
of age who had a chill every second day 



1 88 Tuberculosis 

at eleven o'clock in the morning. The 
fever rose rapidly, until at one o'clock it 
was 106 ; at 3.30 the temperature was 
normal, and the child felt perfectly well, 
this continued for one week. 

The diagnosis in the first class of cases 
is by no means easy. In many instances 
the nature of the illness is not discovered 
and the child is treated for various im- 
aginary ills. 

The usual treatment of malaria in chil- 
dren is by the use of quinine, or by a 
change of climate. The majority of the 
cases recover satisfactorily under quinine, 
but it should never be given without a 
physician's order. The indiscriminate 
giving of quinine whenever a child falls 
ill cannot be too strongly condemned. 

TUBERCULOSIS 

Tuberculosis is an infectious disease 
which carries off one-seventh of the pop- 
ulation of the earth. Children are very 
susceptible to the infection. The disease 
is caused by the entrance into the system 
of a micro-organism known as the tuber- 



Tuberculosis 189 

cle bacillus. Tuberculosis is not inher- 
ited. The disease always comes from 
without, as does typhoid fever or diph- 
theria. We often see parents and children 
in turn sicken and die with the disease. 
This does not necessarily mean heredity, 
however. It means that there is a family 
condition of constitution which furnishes 
a favorable soil for the development of 
the bacillus. If all who swallowed or 
inhaled the tubercle bacillus became tu- 
bercular, the earth would be depopulated 
in a very few years. We all have taken 
the tubercle bacillus into our bodies at 
some time, probably many times. In one 
individual the germ finds a favorable soil 
and flourishes; in another, unfavorable con- 
ditions, — health and vigor of constitution, 
— and it dies. The usual means of infection 
is through the inspired air by the inhalation 
of the infected dust from the public con- 
veyances, from the street, or from infected 
dwellings. Infection may also take place 
by direct contact through kissing. -The 
bacillus may be swallowed with food or 
drink which has been contaminated. 



190 Tuberculosis 

Almost every portion of the body may 
become the seat of the tubercular process. 
When the micro-organism attacks the 
lungs, it produces what is known as 
consumption, or pulmonary tuberculosis. 
When the covering of the brain is in- 
volved, the child has tubercular menin- 
gitis. When the hip-joint is attacked, 
hip-disease follows. When the spine 
is attacked, it produces what is known 
as Pott's disease. When the glands of 
the neck are infected, scrofulous glands 
or tubercular adenitis is the outcome. 
Tubercular disease of the knee is com- 
monly known as white swelling. These are 
the parts which are most frequently the 
seat of the tuberular process. With less 
frequency the bacillus attacks the bladder, 
the kidneys, the skin, the intestines, the 
mesenteric glands, and the peritoneum. 

In institutions and among the poor, 
what is known as general tuberculosis 
causes the death of many infants. At 
autopsy they show an involvement of 
nearly all the internal organs. Tuber- 
culosis in children is always a very serious 



Rickets 191 

disease, but it is not necessarily fatal ; 
many cases recover. When the disease 
involves the spine, hip-joint, or knee-joint, 
or the glands of the neck, the prognosis 
as regards life is usually good. When 
the brain is attacked it is always fatal. 
In tubercular disease of the lungs in very 
young children the prognosis is very 
grave. Many older children — those from 
seven to eight years of age, recover if the 
disease has not progressed too far before 
coming under treatment The important 
features in the management of these 
cases are : change to a dry climate at an 
elevation of one thousand to fifteen hun- 
dred feet, with a most carefully regulated 
diet and close attention to hygiene. 

RICKETS 

Rickets is a constitutional disease due 
to malnutrition. A child with rickets 
either has not received suitable nourish- 
ment, or, if he has received it, it has not 
been assimilated. Lack of nourishment 
manifests itself in characteristic changes 
in the bones, muscles, and in the nervous 



19 2 Rickets 

system. In addition to their physical 
characteristics, children with this disease 
show delayed mental development. A 
rachitic child is usually under weight and 
undersized, particularly as regards length. 
The head is ill-shaped, the enlargement of 
certain bones of the skull giving the head 
a square appearance. The sutures and 
fontanelle close very late. I have seen 
the fontanelle still open at the fourth 
yean The teeth are cut late, are apt to 
be soft, and decay early. Many rachitic 
children do not get the first teeth until 
after the twelfth month is passed. The 
chest is narrow and depressed at the sides, 
and along its anterior portion, at the junc- 
tion of the costal cartilages with the ribs, 
a row of nodules can be traced. The 
ends of the long bones, particularly at the 
wrists and ankles, are very much enlarged. 
In many cases this enlargement is so great 
that it produces quite a deformity. Often 
the legs are curved, a condition known 
as " bow-legs." The spine is weak and 
in severe cases the child is unable to 
sit erect. The abdomen is usually very 



Rickets 193 

prominent. The malnutrition is further 
shown by the flabby, poorly developed 
muscles, by the tendency to perspiration, 
particularly about the head, and by the 
unstable nervous system. These children 
are restless, irritable, and hard to please, 
and they have convulsions under slight 
provocation. Not all rachitic children 
are below weight ; some are quite fat, but 
pale and flabby. The changes in the 
bones, however, are similar in both types. 
In addition to the characteristics noted, 
rachitic children possess feeble powers of 
resistance. They are prone to catarrhal 
affections of the respiratory and intesti- 
nal tracts. In many instances, they teeth 
late and with much difficulty. On account 
of their enfeebled condition, illness in a 
rachitic child is apt to be tedious, if not 
serious. 

The prevention of rickets depends upon 
proper feeding. Condensed milk and the 
proprietary meal foods are responsible for 
a large majority of the cases. Proper 
management requires suitable food, clean- 
liness, fresh air, and cod-liver oil. By 
13 



194 Scurvy 

''suitable food" is meant good milk for 
children under one year, to which meat 
and eggs are added as soon as they can be 
digested — usually after the twelfth month. 
For very rachitic children I order also one 
brine bath daily. 

SCURVY 

Scurvy is a disease of quite frequent 
occurrence among bottle-fed children. It 
is characterized by pain in one or more 
of the joints of the long bones, with or 
without swelling of the involved parts, 
and discolored, spongy, or bleeding gums. 
Hemorrhages into the skin sometimes 
occur, which give the child a peculiar mot- 
tled appearance. The disease is often 
mistaken for rheumatism because of the 
swollen and painful joints. If the case 
is a very severe one it may resemble 
paralysis in some of its aspects. 

The disease is due to errors in nutri- 
tion. The great majority of the cases 
develop in those who are being fed on 
proprietary meal foods, condensed milk, 
and overcooked cows' milk. 



Scurvy 195 

Among the author's thirty cases, one 
symptom was always present : they all 
showed evidences of faulty nutrition ; 
they also presented another symptom in 
common which was the earliest active 
manifestation of the disease, and that 
was pain. The child that has been play- 
ful, active, and has enjoyed attention, 
suddenly undergoes a change — he pre- 
fers to rest in the crib or carriage, cries 
when handled, and refuses to play. Often 
the first signs of trouble will be noticed 
when changing the napkin or putting on 
the shoes or stockings. The movement 
of the diseased parts causes pain and the 
child cries lustily. If he is undressed 
and rests on his back, the affected limb 
in all probability will remain motionless, 
while its companion may be moved freely. 

The symptom of pain appears before 
the swelling of the joints, which is sure 
to follow in case the disease is not recog- 
nized early and treated properly. x\nother 
characteristic symptom is the swollen, con- 
gested, and bleeding gums about the 
upper incisor teeth. This condition is 



19 6 Rheumatism 

sometimes seen early in the attack, but 
it is usually a later symptom. Hemor- 
rhages into the skin are of comparatively 
infrequent occurrence. 

Scurvy uncomplicated is not accom- 
panied by fever. Acute articular rheuma- 
tism is always accompanied by fever. 
Rheumatism is rare in children under two 
years of age ; scurvy is rare in children over 
two years of age. There is no excuse for 
an error in diagnosis between the two 
affections. 

The treatment is : fresh cows' milk, beef 
juice, and orange juice. For a child one 
year of age the juice of one orange should 
be given daily. Under proper treatment 
the average case will be well in a week or 
ten days, improvement being noticed in 
from twenty-four to forty-eight hours 
after beginning the treatment. 

RHEUMATISM 

Rheumatism is a disease of very grave 
import and of rather frequent occurrence 
among children after the third year. It 
may appear in all degrees of severity. 



Rheumatism 197 

The mild attacks are often so slight that 
a physician is not consulted and the diag- 
nosis of rheumatism never made. Such 
cases are often mistaken for sprains and 
so-called " growing pains." Aside from 
this mild type we have the disease in all 
degrees of severity. The severe articular 
form known as inflammatory rheumatism, 
is that in which the child, with high fever, 
throbbing blood-vessels, reddened, swollen 
joints, dreads your approach to the bed- 
side and begs you not to touch him. 
There can be no attack of rheumatism so 
mild that it should be ignored. Every 
child ill with this disease is in danger of 
heart complications which may make him 
an invalid for life. Probably four-fifths 
of the cases of valvular heart disease in 
adults are due to attacks of rheumatism 
during childhood, and in many instances 
the disease of the heart is not recognized 
until long after the rheumatic attack. In 
every case of rheumatism the heart should 
be examined early so that the case may 
be promptly and properly treated. Heart 
involvement is as liable to develop in the 



i9 8 Grippe 

mild as in the severe attacks. In some 
cases it is the only evidence of the pres- 
ence of rheumatism. 

GRIPPE 

Grippe is a disease very prevalent 
among children during the colder months. 
It is due to a micro-organism which is 
usually taken into the system with the 
inspired air. There are four types of 
the disease to be seen in children. 

In the most common type the respira- 
tory passages are the parts chiefly in- 
volved. The symptoms resemble in some 
respects those of a common cold. There 
is running at the nose, cough, sore 
throat, and, generally, bronchitis. There is 
a higher fever, however, than can be 
explained by the catarrhal symptoms, 
greater muscular weakness, and greater 
prostration. If uncomplicated, the dis- 
ease usually runs its course in from five 
to eight days. The complications to be 
especially dreaded are bronchitis, pneu- 
monia, and otitis. 

The next most frequent type of grippe 



Grippe 199 

is the muscular. There are fever, head- 
ache, loss of appetite, prostration, and 
great muscular weakness. There is little 
or no involvement of the respiratory 
tract. 

The third type includes the cases in 
which the intestinal symptoms predomi- 
nate. I saw about twenty of these cases 
during the winter of 1890-91. The chil- 
dren were taken suddenly with fever, pros- 
tration, and diarrhoea which was very hard 
to control. There were from eight to six- 
teen green, watery passages daily, con- 
taining a mocierate amount of mucus, 
streaked with blood. There were also 
slight cough and coryza, with considerable 
congestion of the throat. 

In the fourth type the nervous system 
is chiefly affected. These patients have 
the fever and muscular soreness com- 
mon to all varieties, with the prominent 
symptom — excessive irritability. In some 
cases there seems to be almost entire loss 
of self-control. The patients are peevish, 
fretful, depressed and hysterical by turn. 
They cannot bear the slightest noise, and 



200 Grippe 

sleep only when under the influence of 
drugs. 

The severe cases, however, have two 
symptoms common to all — fever and in- 
tense prostration ; prostration and weak- 
ness out of proportion to all objective 
symptoms are the peculiar characteristics 
of grippe. I have lost two patients aged, 
respectively, three and four months, in both 
of which the system was completely over- 
whelmed by the virulence of the grippe 
poison. Both children died in less than 
twenty-four hours, apparently from ex- 
haustion. Post-mortem examination failed 
to detect in either case any organic change 
sufficient to cause death. 

A very unpleasant feature of grippe is 
the wretched physical condition in which 
the patient is often left after the acute 
symptoms have disappeared. Weeks of 
the most careful treatment will frequently 
be required to restore his previous good 
health. There is no specific treatment for 
this disease. Every case must be treated 
according to the symptoms presented. 
For those which fail to make prompt re- 



-t> 



Convulsions 201 

covery, a change of climate should be ad- 
vised. Many of my patients have done 
surprisingly well at Lakewood, or at At- 
lantic City. 

CONVULSIONS 

A convulsion is a temporary loss of con- 
sciousness, associated with rhythmical con- 
tractions of various muscles of the body. 
Rachitic, delicate children and those suffer- 
ing from malnutrition in any form are 
predisposed to convulsions. Disturbances 
in the gastro-intestinal tract, due to errors 
in feeding, have been the cause in ninety- 
five per cent, of my cases. Nearly all were 
seen among the badly bottle-fed or in those 
beyond the bottle age who had been 
given food unsuited to their years. I have 
frequently known seizures to follow an 
unusual indulgence in cake, pie, or fruit. 
Excessively high fever may be a cause of 
convulsions. Pneumonia, meningitis, and 
contagious diseases are sometimes ushered 
in by convulsions. Heat prostration and 
worms may be mentioned as infrequent 
causes. A patient of mine,— a boy three 



202 Convulsions 

years old, had repeated convulsions until 
he was relieved of forty-three large round- 
worms. According to my observation, 
dentition is never an immediate cause. 
The dentition period covers eighteen 
months, and children often have convul- 
sions during this time ; a thorough ex- 
amination of the patient, however, will 
usually reveal the seat of the trouble in 
the intestinal canal or stomach. Denti- 
tion may indirectly be a factor. A few 
years ago a mother insisted that I should 
lance the healthy gums of a girl eighteen 
months of age, who repeatedly had con- 
vulsions. This I refused to do, and or- 
dered, instead, two teaspoonfuls of castor- 
oil. The child passed one-quarter of a 
partially masticated orange and the con- 
vulsions ceased. 

When a child is attacked, prompt 
action is necessary. The family physi- 
cian should be sent for and the patient 
placed at once in a mustard bath at a 
temperature of 105 F. ; an even table- 
spoonful of mustard should be added to 
five gallons of water. The patient should 



Convulsions 203 

not be allowed to remain in the bath 
over fifteen minutes, when he should be 
removed and dried vigorously. If pos- 
sible, the child's temperature should be 
taken while in the bath, and if above 
102 F. (in convulsions it usually ranges 
between 104 F. and 106 F.) the tem- 
perature of the water should be lowered 
to 75 or 8o° F. by the addition of ice 
or cold water. Watch the effect of the 
cooling of the bath upon the child's tem- 
perature, and when it is reduced to 
101 F., remove him. The temperature 
in convulsions should always be noted. 
To my mind the high fever has often- 
times a great deal to do with the seiz- 
ure. Not long since I was called to see 
a child in convulsions. Upon my arrival 
I learned that he had been put into a 
hot bath at no° F., and kept there fif- 
teen minutes, but the child showed no 
signs of improvement. The temperature 
was taken while in the bath, and regis- 
tered iii° F., as high as the thermometer 
would register. In this case the hot 
bath was the worst means of treatment 



204 Convulsions 

that could be devised. There is no 
advantage in making the water hotter 
than 105 . In the bath, or immediately 
upon removal, give an enema of soap 
and water so as to insure a movement 
of the bowels as soon as possible. As 
soon as the child can swallow, one or two 
teaspoonfuls of castor-oil should be given. 
If it is known that the child has taken 
something indigestible, a teaspoonful of 
syrup of ipecac should be given, and 
repeated in twenty minutes if vomiting 
does not follow. The convulsion is very 
apt to be repeated if the cause is not re- 
moved. The patient should not be held 
on the lap. He should be placed in his 
crib and kept very quiet. Cold cloths 
should be applied to the head and a hot- 
water bag to the feet. No solid food 
or milk should be given for twenty-four 
hours ; broths and barley-water should 
constitute the diet. During the next 
few days there should be no excitement, 
and the physician's orders regarding 
medication and diet should be carefully 
carried out. 



Colic 205 

COLIC 
There are few children who reach the 
age of one year without having suffered 
from colic. Infants in the earliest months 
of life are particularly susceptible to such 
attacks. The majority of cases are seen 
in children under five months of age, al- 
though the seizures may continue until 
a much later period. During the attack 
the child cries violently, becomes red in 
the face, clinches its fists, draws up its 
legs, doubles up its body, and straightens 
out again. The abdomen is hard, often 
distended, and the hands and feet are cold. 
The child rests a few moments and cries 
again. Often all attempts at comforting 
him fail. An attack may continue from 
a few moments to an hour or more, 
perhaps until the child sleeps from ex- 
haustion. I have had children brought 
to me for treatment who were so hoarse 
from crying that they could scarcely utter 
a sound. There may be several attacks 
a day after the feedings or they may not 
appear until evening. Afternoon or even- 
ing colic is probably most frequent. 



206 Colic 

These cases are easily explained. The 
overtaxed stomach has done its work 
fairly well early in the day, but as 
the improper, frequent feedings follow, 
it becomes tired and refuses to work 
" overtime." During the night some rest 
is obtained, but the following day the 
entire programme is repeated. So-called 
colicky children are often otherwise 
perfectly well. If the trouble is not 
particularly severe, they may be well- 
nourished and well-behaved babies when 
not in pain. In the severe cases there 
is apt to be evidence of marked mal- 
nutrition. It is often remarked that 
" a baby must do just so much crying," 
and nothing is done to relieve it. If one 
baby cries more than another it is be- 
cause he suffers more. A baby rarely 
cries unless he is uncomfortable or in 
pain. He may cry while his clothing is 
being changed because it disturbs him ; 
he will cry from cold, hunger, from the 
effects of a misdirected pin, or from pain 
of any nature, but never without any 
re.ason. The general tendency of the 



Colic 207 

child is to play, to smile, and be happy. 
When this is not the case something is 
wrong. 

Colic in every instance means indiges- 
tion. It means, that whether breast-fed 
or bottle-fed, the food is not suitable, — is 
not adapted to the child's digestive powers, 
or not properly given. The child who 
suffers from habitual colic is usually con- 
stipated. It has been my experience that 
the chief error in the diet causing the colic 
was the excess of the proteid — the curd- 
forming element in the milk. It is thus 
practically useless to give carminatives 
and soothing syrups, and other remedies 
of a sedative nature. Whatever error 
may exist in the feeding must be corrected. 
If the patient is a breast-baby we must 
treat the mother, — the source of the child's 
nourishment. Nursing mothers of colicky 
babies are usually of sedentary habits, 
hearty eaters, and constipated. Our first 
step must be to cure the constipation of 
the mother. She should have one full 
free passage from the bowels daily. She 
should exercise in moderation in the open 



208 Colic 

air : a walk of an hour or two in the 
morning, and an hour in the afternoon, 
will be most beneficial. Her diet should 
consist of fresh meat, poultry, fish, ce- 
reals, soups, baked potato, green vegeta- 
bles, and stewed fruit. Coffee may be 
taken in moderation ; milk, cocoa, choco- 
late, and water may be taken freely. A 
nursing mother should drink no tea. It 
is a popular idea that tea is a very 
necessary article for the nursing mother. 
Hardly a week passes but I hear from 
the out-patient mother of a sick breast- 
baby that she is drinking from one to 
two gallons of tea a day. The tea is kept 
"on the back of the stove," so as to be 
ready for use at any time. I have relieved 
many cases of colic in the child simply by 
curing the mother's constipation and reg- 
ulating her diet. 

Menstruation often causes temporary 
attacks of colic and other digestive dis- 
turbances in the child. Fright, anger, 
worry, or anything in the nature of a 
shock in the mother will often seriously 
affect the child's digestion. In short, 



Colic 209 

when the nursing child suffers thus from 
digestive derangements, the error, nine 
times out of ten, rests with the mother. 
The trouble is rarely with the child. 

As previously stated, habitual colic in 
the bottle-fed tells us that we are not giv- 
ing the child a suitable food, or that we 
are not giving a suitable food properly. 
The food as a whole may be too strong or 
too weak. It may be given too frequently. 
If cows' milk is the diet, the error is often 
due to improper modification. The pro- 
teid will usually be found in excess ; not 
in excess, perhaps, for the average child, 
but in excess for the patient in question. 
There can be no set rules for feeding- or 
definite formulae for various ages that are 
infallible. The food of artificially fed 
children must be adapted to meet their 
individual requirements. The treatment 
of habitual colic in the bottle-fed consists 
in rendering the food suitable. 

For the relief of immediate attacks, 
an injection of from six to eight ounces 
of water at no° F., to which one-half 
teaspoonful of salt has been added, will 



2io Constipation 

often be of service. Five to eight drops 
of gin in a teaspoonful of warm water, 
by mouth, is sometimes useful. Two- 
drop doses of Hoffmann's Anodyne in 
two teaspoonfuls of hot water will fre- 
quently cut short a severe attack. Both 
the gin and the anodyne may be repeated 
in one-half hour if relief is not obtained. 
If the attack is prolonged, a hot-water 
bag should be placed at the feet, and 
flannels wrung out of hot water applied to 
the abdomen. Oftentimes, in order that 
the digestive organs may have a complete 
rest, it is advisable to discontinue the 
regular food for a few hours, and give 
barley-water as a substitute. 

CONSTIPATION 

Among the derangements of the young, 
there are few which give more annoyance 
or are harder to manage successfully than 
constipation. The causes of the trouble 
are anatomical and dietetic. The com- 
paratively long large intestine folded upon 
itself in the narrow pelvis offers an ob- 
struction to the free passage of the 



Constipation 211 

intestinal contents. The lack of develop- 
ment of the muscular structure of the 
intestine is also a cause. Deficient nerve 
power, due to lack of development of the 
sympathetic nervous system, is thought 
by many to be an important factor. In 
all probability all these agents may be 
regarded as predisposing causes of con- 
stipation. The chief cause of constipation, 
however, according to my observation, 
is the proteid (the curd) in the child's 
milk. When the amount of proteid is 
excessive, — a higher percentage than 
normal, — the child will be constipated. 
A child fed on a normal proteid with a 
low fat will also probably become con- 
stipated on a milk perfectly adapted, 
because of the difficulty of digesting 
cows'-milk proteid, or because the heat- 
ing of the milk is carried too far. Among 
the breast-fed, the dietetic management 
of this disorder is difficult, for it is hard 
to change the character of the mother's 
milk. Much maybe done, however. In- 
quiry into the daily life of the mother 
will usually disclose sedentary habits, a 



212 Constipation 

good appetite, a fondness for tea, and, 
probably, constipation. An examination 
of the milk of these mothers will show 
that the normal proportions of fat, proteid, 
and sugar are not maintained. The per- 
centage of proteid is usually found to be 
higher than normal, with low or normal 
fat. 

The first step in the treatment is the 
regulation of the habits of the mother. 
The bowels should be evacuated daily, 
with a laxative, if necessary. She should 
be placed on a diet of fresh meat, fresh 
vegetables, and fruit. A malt liquor with 
luncheon or dinner is also sometimes 
recommended. She is instructed to take 
at least three hours' exercise daily in the 
open air. This regime will diminish the 
proteid and increase the fat in her milk, 
and not only relieve constipation in the 
child, but insure better nourishment and 
a later weaning than would otherwise 
be possible. The treatment of the mother 
is all that is necessary in a considerable 
number of cases, but when this fails, the 
child demands attention. 



Constipation 213 

In treating the child my first step is to 
give cream ; not cream purchased as such, 
but cream which rises upon the best milk 
obtainable. I give from one-half to two 
teaspoonfuls in quite warm water immedi- 
ately before nursing. The use of the 
gluten suppository at the same hour for 
several consecutive days will rta much to 
establish the habit of a passage at a 
regular hour each day. 

In case the cream does not agree with 
the child or is ineffective, pure cod-liver 
oil — fifteen to thirty drops three or four 
times a day — may prove beneficial. When 
these measures fail, as they will in a small 
number of cases, further medication will 
be required. 

The treatment of bottle-fed and " run- 
about " children is much easier and the 
results more satisfactory. It is, moreover, 
very simple, and resolves itself largely 
into a manipulation of the fat and the 
proteid. Given a bottle-fed child, six 
months of age, suffering from obstinate 
constipation, and the proteid should at 
once be cut down to a minimum by 



2H Constipation 

prescribing a cream, water, and sugar 
mixture. This should be given raw, 
if practicable. A 16-per-cent. cream is 
desired. Allow the milk which is de- 
livered in bottles at about six o'clock in 
the morning to remain in the refriger- 
ator until noon, when all the cream is 
removed. If the milk is good, the cream 
will contain approximately 16 per cent, of 
fat ; if it deviates from this figure, the per- 
centage will probably be lower. I use the 
pint (sixteen ounces) for a standard. If we 
mix one ounce of this 16-per-cent. cream 
with fifteen ounces of water, we will have 
a i-per-cent. fat mixture. If two ounces 
of cream are mixed with fourteen ounces 
of water, a 2-per-cent. fat mixture will 
result ; if four ounces of cream with twelve 
ounces of water, we will have a 4-per- 
cent, fat mixture. But our 16-per-cent. 
cream contains more than fat. It con- 
tains also, approximately, 3.2 per cent, 
proteid and 3.2 per cent, sugar. If, then, 
we are to prepare a food for this six- 
months', constipated baby, we need a high 
fat mixture, — four per cent., with a low 



Constipation 215 

proteid. In order to obtain it, we use 
four ounces of cream and twelve ounces 
of water. This, as will easily be seen, 
will furnish us a 4-per-cent. fat, 8-per- 
cent, proteid, and 8-tenths-per-cent. sugar. 
The fat is as high as we wish it, the 
proteid low where it ought to be, but the 
sugar is too low, and this we increase 
by the addition of milk sugar or cane 
sugar. 

A word about the low proteid, — .8 of 
one per cent. Compared with the moth- 
er's milk it is low, but we must remember 
that in our modifications we are not deal- 
ing with mothers' milk. In many cases 
it is unwise to attempt to give as high a 
proteid as that contained in mothers' milk, 
for the reason that it is more difficult of 
digestion, and, by reason of its higher 
nutritive properties, it is not required. In 
case the reduction of the proteid is im- 
practicable, or does not furnish relief, I 
add to each feeding of the cream or milk 
mixture, one or two teaspoonfuls of Mel- 
lin's food or malted milk, which will often 
act as a satisfactory laxative. In older 



216 Constipation 

children, — eight or twelve months of age, 
— cream diluted with water is often given 
with oatmeal jelly, — one or two table- 
spoonfuls to each feeding. It is extremely 
rare for a case to resist this treatment, 
and when it happens I usually find the 
stool soft when voided, deficient peristalsis 
being, doubtless, the cause of constipa- 
tion. In such cases medication is required. 

In " run-about " children the use of 
cream and water mixtures, rare meat, 
green vegetables, stewed fruit, zwiebach, 
and bran biscuit, renders the management 
of constipation exceedingly simple. The 
meals must be given at regular intervals, 
and crackers, bread, potatoes, and other 
coarse, starchy foods excluded. The more 
the milk is heated the greater its consti- 
pating effect. 

It is our hope in treating constipation 
to relieve the patient by the dietetic 
measures above suggested. When these 
fail, we must resort to other means. Ene- 
mas and suppositories may be used occa- 
sionally, but the child should not become 
accustomed to them, In the severe cases 



Vaccination 217 

which resist dietetic treatment, the out- 
look for an early recovery is not promising. 

VACCINATION 

Every baby in fair health should be 
vaccinated not later than the third month 
— before any trouble incident to dentition 
may arise ; for the younger the child, the 
less the constitutional disturbance. Vac- 
cination in a child two to three months 
of age causes practically no illness what- 
ever. Both sexes should be vaccinated 
on the outer side of the calf of the leg : 
girls, because the resulting scar on the 
arm may be regarded, in later life, as a 
disfigurement ; and both boys and girls, 
because when the sore is on the leg it is 
more easily cared for. In dressing and 
undressing a child, the arm has to be 
manipulated to a considerable extent, thus 
causing more or less discomfort. The 
wound should be kept covered with a 
sterilized orauze bandage until the crust 
falls, leaving the dry pink skin under- 
neath. Tub bathing should be discon- 
tinued until this takes place. 



218 Vaccination 

Vaccination shields are all worse than 
useless ; they are often positively harmful, 
for they usually become displaced and 
may irritate and infect the sore. When 
unpleasant results follow vaccination, the 
virus is rarely at fault. The infection is 
usually due to carelessness or to uncleanli- 
ness in the treatment of the wound. 

Vaccination will always be considered by 
people who enjoy the possession of an ordi- 
nary amount of knowledge and a moderate 
amount of common sense as one of the 
greatest discoveries of medical science. 
Since its discovery by Jenner, as statistics 
show, millions of lives have been saved by 
vaccination. It would seem strange that 
one should feel it necessary to speak in de- 
fence of a measure which has been of 
such incalculable value to the human race, 
but there are a noisy lot of mentally in- 
competent anti-vaccinationists, who are 
not without influence among their kind, 
and the otherwise ignorant, upon whom 
the following statistics by Allen (Pcedia- 
trics, February, 1900) would produce no 
effect 



Bed- Wetting 219 



In 187 1, Germany lost one hundred and 
forty-three thousand lives by smallpox ; 
in 1874, a law was enacted making vacci- 
nation obligatory during the first year of 
life and compelling its repetition during 
the tenth year. The result was that the 
disease almost entirely disappeared. At 
the present time the loss of life from this 
disease throughout the empire is scarcely 
one hundred a year. At the time of the 
Franco-Prussian War, the entire German 
Army was re-vaccinated ; while in the 
French Army vaccination being optional 
comparatively few were vaccinated. Both 
armies were attacked by smallpox, the 
French losing twenty-three thousand men, 
the Germans, two hundred and seventy- 
eight. With such statistics how can there 
be any plausibility in the argument of the 
anti-vaccinationists ? 

BED-WETTING. 

The urine is voided involuntarily by 
most children until well into the second 
year. If the child is carefully trained, the 
function of urination may be under perfect 



220 Bed- Wetting 

control during the waking hours by the 
end of the first year. We hear now and 
then of a child who urinates voluntarily at 
the age of six months. Such children are 
rare. The urine is passed normally during 
sleep until the child is two and one-half or 
three years of age. In many this will be 
controlled at the end of the second year, 
but I do not regard the lack of control as 
an abnormality until the third year is 
reached. If the urine is passed involun- 
tarily after the child is three years old, a 
physician should be consulted, not neces- 
sarily to give drugs, but to instruct the 
mother as to the diet and general hygiene. 
Incontinence of urine may be due to a 
great variety of causes, among which may 
be mentioned a highly acid urine, stone 
in the bladder, which is of comparatively 
rare occurrence, adenoids, thread-worms, 
constipation, inflammation of the vulva 
and vagina in girls, and tightly adherent 
foreskin in boys. By far the greatest 
number of cases, however, are due to a 
lack of development of the nervous sys- 
tem and, in addition, a bad habit. Not 



Bed-Wetting 221 

infrequently the trouble is caused by too 
freely indulging in water and milk late in 
the afternoon and during the night. It is 
rarely a symptom of kidney or bladder 
disease. The relief of the inveterate bed- 
wetter of five or six years of age is often 
most difficult. The child must be exam- 
ined by a physician to determine that 
there is no local cause for the trouble. If no 
such cause is found, well-directed medica- 
tion, with the mother's cooperation, will 
usually relieve the patient, although it 
may require months to do it. In the 
cases of only occasional bed-wetting, and 
with younger patients, the mother alone 
can often accomplish considerable. Xo 
water or milk should be given after 
four o'clock, p.m. The child should 
have a dry supper, for which I would sug- 
gest farina, hominy, or rice, any of which 
may be served with butter and a little 
sugar. If the child will not take the ce- 
reals without milk, a very little may be 
added. This with stewed fruit and a 
piece of bread is sufficient. The child's 
bedclothing should be light, and he 



222 Care of the Genitals 

should be made to sleep on his side, not 
on his back. In order to prevent the 
child resting on his back, tie a piece of 
any thin goods about the body, with a 
large knot between the shoulders. The 
child should always be taken up at ten or 
eleven o'clock, and made to urinate. 

If there is phimosis, vaginitis, thread- 
worms, or any local disorders, treatment 
of the local conditions may effect a cure. 

A few bed-wetting children are troubled 
with incontinence during the day as well. 
There is a constant leakage, the clothing 
being wet the greater part of the time. 
The management of these cases, however, 
differs in no respect from that advised for 
those first mentioned. 

CARE OF THE GENITALS 

PAINFUL MICTURITION ; CIRCUMCISION 

In girls very little care of the genitals 
is required other than cleanliness. The 
parts should be washed in boiled water 
and castile soap once a day. Sponges 
should not be used. Soft old linen is far 
better, and after once using it should be 



Care of the Genitals 223 

burned. A sponge is never clean after it 
has once been used, and should have no 
place in the nursery outfit. A nurse should 
never begin the baby's bath until she has 
thoroughly cleansed her own hands with 
soap and hot water. After cleansing, the 
parts should be dusted thoroughly with 
the following powder : boracic acid ten 
grains, powdered starch and oxide of zinc 
each one-half ounce. 

With boys more attention is required. 
The normal condition, a free foreskin, non- 
adherent to the glans penis, is necessary 
for his comfort and health. It should be 
stripped back once a day and the parts 
washed very gently with castile soap and 
warm water, dried with absorbent cotton, 
and a bit of vaseline applied. In the 
majority of boys the foreskin at birth is 
tightly adherent to the glans, with only a 
pin-hole opening. Such a condition is 
one of much annoyance to the child. Se- 
cretions which act as a foreign body form 
under the foreskin, producing no little irri- 
tation, drawing the child's attention to the 
parts, and thus often leading directly to 



224 Care of the Genitals 

the habit of masturbation. Inflammation 
of the foreskin and urethra not infre- 
quently follow this condition. As a re- 
sult, urination is painful and the urine is 
retained until the child cannot pass it. I 
have known children for this reason to 
hold their urine for over twenty-four 
hours. In two cases which came under 
my observation, pus formed under the 
foreskin, necessitating immediate opera- 
tion. In two boys aged about two years, 
repeated convulsions occurred, for which 
no reason could be assigned other than 
the irritation caused by the tightly adher- 
ent foreskin and the retained secretions. 
They were circumcised, and have been 
perfectly well during the two years which 
have intervened. Bed-wetting is often a 
direct outcome of this trouble. 

Four out of five of the boys who come 
under my care need circumcision. This 
does not mean that four out of five are 
circumcised, as family objections are often 
hard to overcome, even where the physi- 
cian is convinced that such a measure 
would be beneficial. In a very few cases, 



Retention of Urine ■ 225 

stretching and retracting the foreskin may 
answer every purpose. But such cases are 
rarely attended to properly afterward ; no 
matter how careful the instructions given, 
the adhesions are allowed to re-form, and 
in a short time all the annoying symptoms 
return. When a child is properly circum- 
cised he is relieved for all time. 

RETENTION OF URINE 

This condition often greatly alarms 
mothers. In girls, the most frequent cause 
is pain due to the inflammation of the ure- 
thral orifice and "the adjoining parts, which 
may have been caused either by excessive 
acidity of the urine, or by vaginitis. Re- 
tention sometimes results from taking 
cold ; high fever is sometimes a cause, 
and, in some instances, no cause can be 
discovered. 

In boys the retention may be due to 
urethral irritation produced by excessive 
acidity of the urine ; far more frequently, 
however, the trouble is caused by an in- 
flammation of the foreskin, which is often 

swollen to three or four times its normal 
15 



226 Retention of Urine 

size. In these cases the orifice of the 
urethra will usually be found red and 
swollen. In either sex, if there is reten- 
tion of the urine for over sixteen hours, 
place the child in a tub of warm water at 
a temperature of iio° F. and often urina- 
tion will follow immediately. Another 
useful method of treatment consists in 
the application to the parts of cloths 
wrung out of hot water. Perhaps the 
best results are obtained by the use of 
an enema of a normal salt solution, — a 
teaspoonful of salt to a pint of water, — 
at a temperature of iio b F. ; at least a 
pint should be used for this purpose and 
the child allowed to retain it if he will. 
This treatment rarely fails. If it does, 
the doctor must use the catheter. The 
swelling of the parts in boys is best 
reduced by a wet dressing of a saturated 
solution of boracic acid, which is applied 
on old linen wrapped around the parts 
and changed every half-hour. In girls a 
simple pad composed of several layers of 
old linen should be saturated with the 
boracic-acid solution and similarly applied, 



Nose-Bleed 227 

the dressing being changed every hour, 
and the parts gently bathed with the 
solution. 

NOSE-BLEED 

Nose-bleed may result from a fall or 
blow, or from any direct injury to the nose. 
In most instances, however, it occurs in- 
dependently of injury. Adenoids are 
frequently a cause of nose-bleed. Small 
ulcers often form on the nasal septum of 
delicate, poorly-nourished children, and 
give rise to most obstinate hemorrhage. 
Habitual and severe nose-bleed, particu- 
larly from one nostril, is usually due to 
this cause. Whatever may be the cause 
of the hemorrhage the immediate man- 
agement must be the same. The child 
should sit erect and the nose be firmly 
compressed for twenty minutes between 
the thumb and finger. The tips of the 
thumb and finger should touch the lower 
portion of the nasal bones. The appli- 
cation of ice is also beneficial ; a small 
piece of ice being wrapped in a handker- 
chief and held against the nostril from 



228 Worms 

which the blood is flowing. After the 
hemorrhage has ceased, continue the ap- 
plication of ice-cloths for one-half hour, 
and watch the child so as to prevent his 
blowing the nose. If the hemorrhage is 
severe, or if slight hemorrhages are re- 
peated, a physician must be consulted. 

WORMS 

There are three varieties of worms 
commonly met with in children ; the round- 
worm, the thread-worm, and the tape- 
worm. 

Round-worms occur most frequently in 
children from two to ten years of age, 
although no age is exempt. When a 
child picks its nose, grinds its teeth at 
night, sleeps poorly, has a coated tongue, 
and an indifferent appetite, it is supposed 
by the older members of the family to have 
"worms." These symptoms may indi- 
cate the round-worms, but they far more 
frequently indicate a too close acquaint- 
ance with gingerbread and jam and 
other cupboard, between-meal indulgences. 
Frequent attacks of colic, constipation 



Worms 229 

alternating with diarrhoea, and convulsions 
are, in my judgment, the most reliable 
symptoms of round-worms. The only 
positive means of diagnosis, however, is 
the discovery of the worm itself, or the 
presence of the eggs in the stools. The 
round-worm resembles the common earth- 
worm. It is usually from five to nine inches 
in length and inhabits the small intestine. 
Round-worms are seldom seen among 
city children ; in the country, however, 
they occur with much greater frequency. 

Thread-worms inhabit the lower por- 
tion of the large intestine, and in ap- 
pearance are like pieces of white thread. 
They are usually from one-quarter to one- 
half inch in length. They are very fre- 
quently seen among the dirty children of 
the tenements. Occasionally they occur 
in children of the better classes. 

The chief symptom of these worms is 
an itching or irritation about the anus. 
The child is restless and sleeps poorly. 
In girls there will be a vaginal discharge 
due to the irritation caused by the worms, 
which have migrated to these parts. 



230 Worms 

Frequently the only symptoms of discom- 
fort will be manifested when the child 
is put to bed. He will then complain of 
a biting, burning sensation in the rectum. 
In some, the rectal irritation is so great 
as to cause very pronounced nervous 
symptoms. 

Some years ago I treated a six-year- 
old girl for involuntary movement of the 
arm and shoulders somewhat resembling 
St. Vitus's dance. The trouble disap- 
peared after several weeks' treatment 
for the thread-worms which were present 
in large numbers. I have seen many 
cases of prolapse of the bowel due to the 
straining which was caused by the irritant 
action of the worms. In both sexes they 
may be a cause of bed-wetting and in 
girls are not an infrequent cause of mas- 
turbation. In some instances after treat- 
ment the worms will be passed in great 
numbers in the stools, and may some- 
times be seen adhering to the skin of the 
parts. 

Tape-worms in children are very rarely 
seen in this country. I have seen but 



Cuts, Bruises, and Strains 231 

one case among many thousands of chil- 
dren treated during the past twelve years. 
The presence of the tape-worm is indica- 
ted by various indefinite manifestations. 
Constipation alternating with diarrhoea, 
are prominent symptoms. The child is 
often ravenously hungry. A positive 
diagnosis can be made only after the dis- 
charge of segments of the worm, which 
appear like short pieces of narrow white 
tape linked together. 

The diagnosis and treatment of worms 
in the children of the household appear 
to be a jealously guarded function of the 
good grandmother. Young mothers, how- 
ever, will do well to have the family phys- 
ician usurp this prerogative. 

CUTS, BRUISES, AND SPRAINS 

Apparently every child must have his 
share of cuts and bruises. In case of a 
cut with considerable hemorrhage, pres- 
sure to the injured parts with cloths 
saturated with cold water will aid in check- 
ing the hemorrhage ; later, a wet dressing 
of a saturated solution of boracic acid 



232 Excitement 

may be applied on clean muslin or clean 
old linen. 

If there is a bruise with much swelling 
to be treated, the wet dressing with the 
boracic-acid solution will relieve the 
condition. The dressing may be con- 
tinued for two or three hours if required, 
the bandages being frequently saturated 
with the solution in order to keep them 
wet until the doctor arrives. 

A sprain may be treated in a similar 
manner. The wet bandages should be 
bound around the injured joint, which, if 
a lower extremity is involved, is kept on 
a level with the body. Severe sprains, 
cuts, and bruises require medical atten- 
tion at the earliest possible moment. 

EXCITEMENT 

A baby should not be subjected to 
excitement or its equivalent — too active 
entertainment. The nervous system of 
an infant is in such an undeveloped state 
that what would be a decided tax upon 
it cannot be appreciated by adults, who 
are often apparently insensible of the 



Excitement 233 

fact that children are different from them- 
selves. 

The first child in a well-to-do family is 
usually the greatest sufferer from super- 
fluous attention, — being a source of unend- 
ing admiration on the part of family and 
friends. He is present very early in life 
at all important functions. Christmas, 
Thanksgiving, birthday celebrations, and 
afternoon teas find him the centre of at- 
traction. He is handed from one guest 
to another and is tossed upon various an- 
gular knees. He is kissed by lips which 
dare touch only those who cannot protect 
themselves. He is talked to with a very 
loud voice in many languages which no 
one understands, and grimaces are made 
at him that can be seen at no other time. I 
have witnessed such scenes many times, and 
have treated many exhausted infants who 
required medical attention after the seance 
was over. I have, indeed, seen infants 
brought thus to the verge of collapse. One 
child of eleven months had convulsions 
which were indirectly due to the fatigue 
incident to a Thanksgiving celebration, 



234 Sleep 

KISSING 

The baby should never be kissed upon 
the mouth by any one. Make this a 
rule and enforce it. A servant who is 
seen kissing a child after having been 
forbidden to do so should be discharged 
at once, no matter how valuable she may 
be. She is unsafe. Tuberculosis, diph- 
theria, influenza, syphilis, and all the in- 
fectious diseases may be transmitted in 
this way. I have treated an infant for 
syphilis which was transmitted by a kiss 
from a diseased woman. Kissing the 
baby upon the hands is almost as danger- 
ous as kissing him upon the mouth, for 
during the next few seconds the baby's 
hands will surely find their way to his 
mouth. 

SLEEP 

A child who is a good sleeper will, al- 
most without exception, be a well-nour- 
ished, normal child. I never knew a child 
of any age that I thought slept too 
much. Children vary greatly as to habits 
of sleep, and no hard and fast rules can 



Crying 235 

be laid down to gfovern it. Children 
of one or two months will sleep from 
twenty to twenty-two hours out of the 
twenty-four. As they grow older less 
sleep is required, and at one year twelve 
to fifteen hours daily usually suffices. As 
to when the child should discontinue the 
morning or afternoon nap, the mother 
alone must be the judge. If the night's 
rest is interfered with by too much sleep 
during the day, the latter must be cut 
down, either the morning or afternoon 
nap being shortened or discontinued. 
After the first year the child should not 
be allowed to sleep between 3:30 and 
bedtime. 

CRYING 

Much has been written regarding the 
diagnostic value of the infant's cry. 
There is supposed to be a special cry for 
earache, and another for stomach-ache ; 
then there is a cry for anger, a cry for 
hunger, a pin-sticking cry, and various 
other cries, which depend for their recog- 
nition upon the fertility of the imagination 



236 Crying 

of the writer. There is a difference 
between the cry of pain, the cry of hun- 
ger, and the cry of anger ; further than 
this we cannot go. A moderate amount 
of crying is of advantage to the young 
baby, for the muscular movements that 
accompany it provide the means for 
his needed exercise. In this way the 
lungs are expanded and the blood is 
purified. 

The habitual criers, the restless, whin- 
ing infants, are uncomfortable ; something 
is wrong. The trouble with these infants 
will very often be found in the gastro- 
intestinal tract, — they suffer only from in- 
digestion. If well trained, a healthy child 
whose nourishment is as it should be is 
never troublesome. Babies are all natural- 
ly good-natured and happy intheirown way. 

Inflammation of the skin of the but- 
tocks and genitals is often a cause of 
a great deal of discomfort, as are also 
tight clothing and over-dressing, particu- 
larly in summer. Badly managed babies, 
— those who have been spoiled by too 
much attention, cry when left alone, but 



Cold Hands and Feet 237 

when they are taken up and talked to the 
crying ceases. Such cases require disci- 
pline only. 

CLEANLINESS 

Much has been said and written regard- 
ing the necessity of cleanliness so far as 
the child is concerned ; but not only 
should the nurse and mother see that the 
baby is clean ; they must be clean them- 
selves. Immediately after every attention 
to the napkin the hands should be washed 
with hot water and soap and a stiff brush. 
This cleansing process must be repeated 
before the preparation of the food or any 
manipulation of the feeding apparatus. 

The child's attendants should not have 
decayed or neglected teeth. The tooth- 
brush should be an important article in 
the outfit of every nurse. She should take 
a tub bath or sponge bath daily. The 
hands and finger-nails of many nursery- 
maids will bear watching. 

COLD HANDS AND FEET 
The hands and feet of the infant should 
never be cold to the touch. This is a 



238 Foreign Bodies Swallowed 

cause of much of his discomfort and rest- 
lessness. A very young child with poor 
circulation will be made much more com- 
fortable by placing a hot-water bag at his 
feet. Bottles filled with warm water and 
wrapped in flannel will keep the upper 
extremities warm. In using hot-water 
bags and bottles be sure that the water 
is not too hot. Severe burning accidents 
have resulted from carelessness in this 
particular. 

FOREIGN BODIES SWALLOWED 

The child's stomach is a frequent re- 
ceptacle for objects for which it was never 
intended. Pins, buttons, safety-pins, small 
pieces of chalk, pencils, etc., often find 
their way into the stomach of the "run- 
about " child. I knew one child to swal- 
low an open safety-pin, and another to 
swallow a stick-pin, the head of which 
was a small four-leafed clover. Both 
children passed the pins without the least 
harm resulting. In order that the object 
swallowed may not injure the child, give 
starchy substances in large amount : oat- 



Foreign Bodies in Ear and Nose 239 

meal, potatoes, corn-meal mush, — sub- 
stances which in the intestines form a 
semi-solid mass in which the object swal- 
lowed may become imbedded and carried 
forward. These cases should never be 
given castor oil or any other laxative. 

FOREIGN BODIES IN THE EAR AND NOSE 

This subject is brought to the attention 
of mothers, to warn them against any 
attempt at the removal of foreign bodies 
from the nose or ears of one of their chil- 
dren. The means often thus employed, 
such as hairpins, button-hooks, etc., should 
never be used, as they are liable to do 
much harm. I have often removed shoe- 
buttons, peas, beans, pieces of coal, and 
pebbles from the nose, and have had 
trouble only with those cases in which 
some member of the family had attempted 
the removal with the result of forcing the 
foreign body farther into the cavity. 
When the foreign body is in the nose, 
the child, if old enough, can sometimes 
remove the obstacle by pressing upon the 



240 Flies and Mosquitoes 

unobstructed nostril while he vigorously 
blows the nose. 

DANGERS FROM FLIES AND 
MOSQUITOES 

The windows of the nursery should be 
screened so that flies and mosquitoes 
cannot enter. When out of doors the 
very young child should be protected by 
mosquito-netting. M osquitoes severely 
poison many children, and are of especial 
danger in that one variety is capable of 
inoculating the child with malaria, the 
Plasmodium malarice being deposited 
along with the other poison. 

Flies, in addition to disturbing sleep, 
are a source of much danger which is 
but little appreciated. The fly enters 
the nursery and alights on the nipple 
of the nursing-bottle. This may take 
place while the child is resting for a sec- 
ond or two during his meal, as flies are 
very fond of the sweet milk which may 
adhere to the nipple ; or the fly may 
alight upon the child's bread, or the pre- 
pared cereal, or any article of food, par- 



The Doctor 241 

ticularly if there is a sweet element in it. 
The last place the fly rested before reach- 
ing the nursery we never know. It may 
have been on animal excrement, or tuber- 
cular sputum, or the infectious discharges 
of a typhoid-fever patient. In this way 
the flies' feet and legs are the means of 
transporting the germs of yellow fever, 
cholera, tuberculosis, typhoid fever, or 
diphtheria. Tuberculosis is unquestionably 
transferred in this way very frequently, 
minor ailments with still greater frequency. 
Flies are a source of danger in the house, 
and should be driven out or destroyed. 

WHEN TO SEND FOR THE DOCTOR 

This question is easily answered. Send 
for the doctor when there are any indi- 
cations of illness in the child which the 
mother does not understand. It is bet- 
ter to be overcautious in this respect 
than to join the great number of mothers 
who are never free from the bitter, life- 
long regret, " The child might have been 
saved had he been treated in time. ,, I 
know such mothers. 



242 Patent Medicines 

There are two conditions in which the 
mother must not trust herself for a mo- 
ment. These are summer diarrhoea and 
sore throat. " Only a summer diarrhoea," 
and "only a sore throat," and "only a 
teething diarrhoea," have sacrificed the 
lives of hundreds of infants. 

Diphtheria is a very prevalent disease, 
and the successful treatment of it re- 
quries that the child be seen by the physi- 
cian at the earliest possible moment. So, 
also, with summer diarrhoea. I have seen 
infants die in twelve hours with the dis- 
ease;. Calling a doctor early is a means 
not only of safety, but of economy. In 
the correction of slight ailments, grave 
ones are avoided. 

PATENT MEDICINES 

Patent medicines should form no part 
of the nursery outfit. The mothers home 
remedies should all be approved by a 
physician. Cough mixtures and sooth- 
ing syrups, the advantages of which are 
so faithfully portrayed in the popular 
magazines and religious periodicals, are 



Summer Resorts 243 

often very harmful. Most of them con- 
tain opium and morphine. Time and 
again I have seen children drugged to 
the point of stupor by these remedies. 

SUMMER RESORTS 

Where to take the child for the summer 
is a vexed question which arises once a 
year in many households. Several years 
of observation of a ereat many children 
who have spent the summer out of town 
have led me to the following conclusions : 

1. The most desirable summer outing: 
the first half of the season at the sea- 
shore, the remainder inland, preferably 
in the mountains. 

2. The next in order of desirability : 
inland, preferably the mountains for the 
entire summer. 

3. The least desirable, the seashore for 
the entire summer. 

I do not wish it understood that many 
children will not do well at the seashore 
if kept there the entire summer ; some, 
indeed, improve wonderfully, but among 
my own patients I have been repeatedly 



244 Summer Resorts 

impressed with the disadvantages of a 
prolonged outing by the sea. The sea- 
shore children, as a rule, do not return 
to the city in the fall with the vigor, 
appetite, and general robustness which 
characterize those who return from the 
mountains. I refer only to New York 
children whose home is a seaport, and 
who thrive best when given the advantage 
of a complete change to the dry, invigorat- 
ing air of the mountains. Children with 
catarrhal tendencies, adenoids, bronchitis, 
and rheumatism, and those convalescent 
from pneumonia, should not go to the 
seashore. 

In selecting an inland resort, the moun- 
tains, by which we understand an eleva- 
tion of from fifteen hundred to two 
thousand feet, are not always necessary. 
The place selected, however, should have 
an elevation of at least six hundred feet, 
and should not be within sixty miles of 
the coast. Children who are subject to 
rheumatism and bronchitis do best on a 
sandy soil, in a dry climate, with the sleep- 
ing rooms above the ground floor. 



Drug-Giving 245 

Another point to be considered in this 
connection is the kitchen facilities which 
will be provided for the preparation of 
the child's food. As a rule, the larger 
hotels refuse the right of way to the 
kitchen ; or, if they do not, it is at the 
expense of many material attentions to 
the chef . I find that mothers are given 
much more latitude as to these matters in 
the smaller hotels and boarding-houses. 
The proper preparation of a child's food 
in the cramped quarters of the sleep- 
ing apartment is not impossible, but it is 
very difficult. 

Before selecting a summer home, the 
drainage, the milk, and the water supply 
must be considered. If the parents pos- 
sess the means, a cottage should be rented 
which will insure them all the comforts of 
home. 

DRUG-GIVING 

Drugs are of service only in the hands 
of those who are trained in their use. 
Mothers often acquire the habit of treat- 
ing their children. Self-prescribing is 



246 Days to Go Out 

greatly overdone in this country among 
all classes. Many people know just 
enough about medicines to be dangerous 
members of society. The proprietary 
cough mixtures, soothing syrups, teas, 
carminatives, etc., are often injurious. 
They usually contain opium, — a drug 
which a mother should never think of giv- 
ing her baby on her own responsibility. It 
is not at all uncommon in hospital work to 
have children admitted in an opium stupor 
which resists all treatment for hours. 

While the habit of promiscuous drug- 
giving is to be condemned, the mother is 
not supposed to remain inactive while 
awaiting the arrival of the physician ; a 
preliminary dose of castor oil in diarrhoea, 
or syrup of ipecac in croup, or rhubarb 
and soda when there is a furred tongue in 
indigestion, will always be in order. The 
mother may have her home remedies, but 
the physician must instruct her in their use. 

DAYS TO GO OUT 

The baby should not go out in stormy 
weather. If under one year of age he 



Children's Parties 247 

should not go out if the temperature is 
below 20 F. During the midday heat 
of summer the baby is better off in the 
largest and coolest room in the house 
or on a shady veranda. On very windy 
days the outing should be postponed. 
When the snow is melting in large quan- 
tities the baby is better off in-doors. On 
stormy and very cold days give an in- 
door airing. For this the baby is dressed 
as for the daily outing. All the windows 
of the nursery or some other large room 
are opened and the child is placed in his 
carriage and wheeled about the room for 
an hour. This method of giving a child 
fresh air will be found particularly useful 
with the very delicate, who, by reason of 
their condition, are not able to # go out 
of doors for weeks at a time. 

CHILDREN'S PARTIES 

It is a custom very common in New 
York City to give birthday parties for 
children from one to four years of age. 
The first party is usually given when the 
child is one year old, to celebrate that 



248 Children's Parties 

event With each succeeding year the 
party is repeated, from six to ten little 
guests being usually invited. The little 
host is too young to entertain the six to 
ten little guests unassisted, and the ser- 
vices of the fond, proud mother are re- 
quired. The six to ten little guests are 
too young to make the journey unat- 
tended, and they must be accompanied by 
their six to ten fond, proud mothers. The 
six to ten fond, proud mothers then have 
an excellent opportunity to point out to 
one another the hidden merits of their 
respective offspring. 

I have been present at a few of these 
parties. An all - important feature of 
the interesting programme is the ban- 
quet ; the menu consisting principally 
of animal crackers, pink and yellow ice- 
cream, and red lemonade. The party 
usually breaks up at the end of three or 
four hours and each little guest is re- 
moved to his home, tired and nervous 
from the excitement of the occasion, with 
a stomach filled with forbidden and un- 
usual articles of diet He is promptly 



Children's Parties 249 

taken with vomiting and diarrhoea and 
perhaps a " birthday-party convulsion." 

Time and again I have seen children 
made seriously ill, and, on two occasions, 
fatally so, by a birthday party. Not long 
since a patient, — a little boy four years 
old, invited fourteen little boys and girls 
of corresponding ages to celebrate his 
birthday. The little host was more gen- 
erous than was his wont ; he gave more 
than the banquet ! The night of the 
birthday party he was very uncomfortable. 
The following day he developed chicken- 
pox. In due course of time twelve of 
the fourteen little guests came down with 
chicken-pox. They were fortunate that 
it was only chicken-pox ; it might have 
been scarlet fever or diphtheria. 

In the close contact of city life, children 
are unavoidably exposed to contagious 
diseases. School children are very liable 
to become infected, but by this time they 
have reached an age when they can more 
easily bear such an illness. The unneces- 
sary bringing together of infants and little 
" run-abouts " is always to be avoided. 



250 Early Exercise 

BASKETS FOR EARLY EXERCISE 
It is a great mistake to have the infant 
constantly in arms. The first baby suf- 
fers more in this respect than later chil- 
dren. When the child is held, there is 
always a tendency to make him sit on the 
arm or the knee without proper support, 
or to toss about or handle him regardless 
of consequences. The bones and liga- 
ments of the spinal column are not suffi- 
ciently developed to bear the weight of 
the heavy head and trunk, and, as a result, 
as the child grows older, spinal curvature 
and other deformities not infrequently 
follow. By urging him to stand on the 
lap the legs are used more than is advisa- 
ble, and we find bow-legs or knock-knees 
very prevalent. 

A large clothes-basket, in which a thick 
blanket has been placed (see Fig. 9), fur- 
nishes a safe and satisfactory playground. 
For the first few months the child will rest 
on his back and amuse himself in his own 
peculiar way. When he can sit up, suppor- 
ted by a pillow at his back the basket gives 
him plenty of room for toys and other baby 



Night Terrors 



251 




FIG. 9. BASKET EOR EARLY EXERCISE 

requirements. In it the baby is practi- 
cally safe. He is not apt to be injured by 
young members of the family in rough 
play. He cannot crawl to the stove to be 
burned, and is in no danger of rolling 
down-stairs. When he can stand, and be- 
gins to walk, the basket period is at an end. 

NIGHT TERRORS 

The child awakens suddenly from sleep, 
cries out with fear, and begs to be pro- 
tected from men and animals, which he 



252 Night Terrors 

imagines are trying to injure him. In 
some cases the nurse and immediate rela- 
tives of the family will not be recognized. 
The seizures may occur quite regularly 
every night until the cause is removed. 
Other children may have but one or 
two attacks in a week. The seizures are 
usually due to a disordered digestive tract 
in a nervous child. Adenoids and en- 
larged tonsils are considered by some to act 
as a predisposing cause. Anxiety regard- 
ing school duties, or over work at school 
may help to bring on an attack ; worms 
may also be a cause. My cases have all 
been due either to acute or chronic diges- 
tive disturbances in nervous children. A 
boy patient twelve years of age has had 
two attacks every year, with one exception, 
since he was six years old. These attacks 
always occur on the nights after Christ- 
mas and his birthday, after indulgence in 
all sorts of unsuitable articles of food. 

During the attack the child must be 
treated with gentleness ; scolding makes 
matters worse. If possible, he should 
be induced to go to sleep ; oftentimes a 



Scales for Weighing 253 

change to the bed of the nurse or mother 
for the remainder of the night will be all 
that is necessary ; or a light may be left 
burning in the room. The attacks may 
usually be prevented by a suitable diet. 
The evening meal should be very light — 
a cereal with milk and a little stewed fruit 
is sufficient. This light supper has re- 
lieved several of my patients of habitual 
night terrors. 

SCALES FOR WEIGHING 

There are, on the market several va- 
rieties of scales for 'weighing the baby, 
which are known as " baby scales." The 
usual construction is that of a basket, 
into which the baby is placed, sup- 
ported by a rod which rests upon a 
spring. A needle indicates on a dial the 
weight of the child. The scales are de- 
scribed in detail, so that the mother may 
recognize them at sight and not buy them. 
They get out of order easily, are expen- 
sive, and, with a vigorous, kicking, crying 
baby, the rapid oscillations of the needle 
prevent the weight being read with any 



254 



The Exercise Pen 



degree of accuracy. The scoop and plat- 
form scales used by grocers (see Fig. 10) 
answer the purpose far better than any 
others. They can be bought for three 




FIG. IO. SCOOP AND PLATFORM SCALES 



dollars, do not get out of order, and 
weigh correctly from one-half ounce to 
two hundred and eighty pounds. 

THE EXERCISE PEN 

In a previous chapter, in speaking of 
cold and how children were exposed to 



The Exercise Pen 255 

influences which might bring about what 
is known as a "cold," the custom of al- 
lowing a child to sit on the floor is re- 
ferred to. 

To keep a child from eight to twenty- 
four months of age off the floor during 
the winter months, and thereby prevent 
his taking cold, is a very difficult matter. 
In fact, with active children who are learn- 
ing to walk, or who have just learned to 
walk, it is practically impossible. During 
this season of the year there is always a 
current of cold air near the floor, and 
allowing the child to creep on the floor 
in winter, even if it is protected by rug 
and pillows, is one of the surest ways of 
taking cold. If he is allowed to walk 
on the floor he is very sure to sit in a 
very few minutes. If he is not allowed 
to creep and walk about at will he will 
not get the proper exercise, and will show 
faulty development ; for such cases I have 
found the exercise pen (see Fig. 11) of 
immense service. After being dressed, 
washed, and fed, the infant is placed in 
the pen on a rug or quilt, toys are given 



256 The Exercise Pen 

him, and the door closed. He can now 
roam about at will, stand up, sit down, 
roll, creep, or walk without danger of 
physical harm from rolling down-stairs, 
being burned, or being stepped on. He 
is thus given an opportunity for active 
exercise without a possible chance of 
injury. 

A young mother of two children will 
take her "pen" into the country in the 
summer and place it in the shade for use 
while the dew is on the grass. The pen 
can be made of any size, — 4 x 6 ft. is 
probably the most convenient. It is so 
constructed as to be taken apart and put 
together in a few moments. In case the 
nursery is small it can be made so as to 
fit over the nurse's bed and consequently 
does not require any additional space. 
In a large nursery it can be placed per- 
manently in one corner of the room, thus 
avoiding the trouble of putting it up and 
taking it down. 

Note. — The pen is made by Elton Perry, 2123 Broadway, 
New York. 



258 Medicine Satchel 

SIMPSON'S MEDICINE SATCHEL 

A mother of one or more children, on 
going to the country for the summer, 
invariably takes with her certain home 
remedies and medical appliances which 
are absolutely necessary for the comfort 
and safety of the family. 

Bottles containing liquids and jars with 
ointments and boxes of powder are diffi- 
cult to pack securely, and hard to find 
when wanted in a hurry. The mother of 
one of my patients feeling the need of 
a vehicle, compact and safe, in which she 
could carry medicines and nursery neces- 
sities, devised the medicine satchel (see 
Fig. 12). 

The satchel is 11 inches long, 9^ inches 
wide, and 9^ inches high. It is strongly 
made, and so constructed as to rest on one 
end on a table or mantel, thus forming a 
cabinet. The bottles and jars are held 
in pockets of strong leather, which revolve 
on a steel rod which holds them in posi- 
tion. This satchel will be found admira- 
bly adapted for its purpose. 



Medicine Satchel 259 

The contents are as follows : 
Three eight-ounce bottles, 
Nine two-ounce bottles, 
Six one-ounce bottles, 
Six two-drachm wide-mouthed bottles, 
with screw metal cap, 




fig. 12. Simpson's medicine satchel 

Three ointment jars, 
Fountain syringe, 
Hot-water bag, 
Ear syringe, 
Absorbent cotton, 
Mustard plasters, 
Court plaster, 
Surgeon's adhesive plaster, 
Medicine-glass, graduated, 
Glass funnel, 



260 Formulae 

Clinical thermometer, 
Spoon, 

Minim measuring-glass, 
Medicine-dropper, 
Tweezers, 
Scissors, 
Corkscrew, 
• Knife, 
Pencil, 

Labels for bottles, 
Bandages. 

FORMULAE 

Beef Juice. — Take a round steak, cut 
into pieces the size of a horse-chestnut, 
place in a buttered pan in a hot oven, 
and bake for fifteen minutes ; remove 
from the pan and press out blood with 
a lemon-squeezer or meat-press. Or, 
broil round steak very rare, cut into 
small pieces, place in lemon-squeezer or 
meat-press, and press out the blood, and a 
little salt. 

Beef, Mutton, and Chicken Broth. — 
Take one pound of meat free from fat, 

Note. — The satchel may be obtained of Fraser & Co., New 
York. 



Formulae 261 

cook for three hours in one quart of 
water, adding water from time to time, 
so that when the cooking is completed 
there will be one pint of broth. When 
the broth is cool, remove the fat, strain, 
and add salt. 

Oatmeal Jelly. — Oatmeal, four ounces, 
water, one pint ; boil for three hours in 
a double boiler, water being added, so 
that when the cooking is completed a 
thin paste will be formed. This while hot 
is forced through a colander to remove 
the coarser particles. When cold, a semi- 
solid mass will be formed. 

Wheat Jelly and Barley Jelly. — Wheat 
jelly and barley jelly are made in the 
same way as oatmeal jelly, using cracked 
wheat or barley grains. 

Scraped BeeJ. — Broil round steak 
slightly over a brisk fire. Split the steak 
and scrape out pulp, using a dull knife. 

Egg-Water. — The white of one ^gg, 
thoroughly beaten in one pint of cold, 
boiled water ; strain ; add a pinch of salt. 

Bar ley- Water. — Robinson's Barley 
Flour, one tablespoonful, water, one pint. 



262 Formulae 

Boil twenty minutes ; strain ; add water 
to make one pint ; add a pinch of salt. 

Whey. — Put one pint of fresh milk into 
a saucepan and heat it lukewarm (not 
over ioo° F.), then add two (2) teaspoon- 
fuls of Fairchild's Essence of Pepsine, 
and stir just enough to mix. Let it 
stand until firmly jellied, then beat with 
a fork until it is finely divided ; strain, 
and the whey (the liquid part) is ready 
for use. 

Rice-Water: — Rice, one tablespoonful ; 
water, one pint ; boil three hours, adding 
water from time to time, so that there 
is one pint of rice-water at the end of 
the three hours. Add a pinch of salt. 

Dextrinized Bar ley- Water. — Robinson's 
Barley Flour, three tablespoonfuls ; water, 
one pint ; boil twenty minutes ; strain ; 
add water to make a pint. When luke- 
warm (ioo° F.), add one teaspoonful of 
Cereo ; also a pinch of salt. 



Till the Doctor Comes 

AND HOW TO HELP HIM 

By George H. Hope, M.D. A popular guide 
in all cases of accident and sudden illness. 
New edition, practically revised and brought 
up to date by Mary J. Kydp, M.D. 

i6° $1.00 

"A most admirable treatise; short, concise, and practical." — 
Harpers Monthly. 



Emergencies 



HOW TO AVOID THEM AND HOW TO 
MEET THEM 

Compiled by Burt G. Wilder, M.D., Pro- 
fessor of Physiology, Cornell University. 

Paper - - 20 cents 

"This valuable little pamphlet should be in every house. It 
gives the remedies for poisons, and the treatment in a great 
variety of accidents." — Chicago Inter-Ocean. 

11 This pocket manual is worth many times the price asked for 
it. Every family must feel the need of some such helpful little 
book." — Rural New Yorker. 

11 This volume will be a valuable hand-book for every one." — 
Library Table. 

* l It contains the very word that may be absolutely needed, and 
no words that are superfluous. Everybody should have one." — 
Watchman. 



Q. P. PUTNAM'S SONS, New York & London 



HEALTH NOTES FOR STUDENTS. By 

Burt G. Wilder, M.D., Professor of Physiology, 
Cornell University and the Medical School of Maine. 
Paper . . . . . . . ,20 cts 

A SELECTION FROM THE CONTENTS. 
Maxims and General Remarks ; Choice of Room ; Drainage ; 
Food and Drink; Ventilation and Heating ; Clothing ; Hathing; 
Care of the Hands, etc. ; Sleep — Its Importance to Students ; 
Exercise; Methods of Study ; Care of the Eyes ; Stimulants 
and Narcotics ; Hygiene and Morality. 



11 They are admirable, and within the reach of everybody in 
this highly condensed form." — Post, Hartford. 

14 It is full of practical and thoroughly sensible suggestions, 
concisely and clearly phrased." — Courier, Boston. 

" Its attentive perusal would prolong the life and preserve 
the health of many a young man, be he student or no student." 
—Phila. Inquirer. r 

u If this simple, brief advice could be mentally d gested by 
everyone, the labors of the medical profession would be ma- 
terially lightened." — A merican. 

" Many thanks for the 4 Health Notes ' which ought to be very 
useful, as they will be, I trust, among our young men, who are 
in great need of such advice, at all times, and everywhere." — 
Oliver Wendell Holmes, Nov. 8, 1883. 



G. P. PUTNAM'S SONS, NEW YORK. 



Dec ao<!90l 



DEC 16 1901 



